The three roles side by side
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| Role | Where the work is | Federal training floor | National median pay (BLS OEWS, May 2025) |
|---|---|---|---|
| Home health aide (HHA) | Patients' homes, through a Medicare-certified home health agency | 75 hours of classroom and supervised practical training, then a competency evaluation (42 CFR 484.80) | $17.21 an hour (SOC 31-1120, shared with personal care aides) |
| Personal care aide (PCA) | Clients' homes, group homes and day programs, often paid by Medicaid | None. The aide must be "qualified to provide such services" under state rules (42 CFR 440.167) | $17.21 an hour (same SOC code as HHAs) |
| Certified nursing assistant (CNA) | Nursing homes, hospitals, assisted living | 75 clock hours including 16 hours of supervised practical training, a state exam, and a listing on the state nurse aide registry (42 CFR 483.152, 483.154, 483.156); most states add hours | $20.32 an hour (SOC 31-1131) |
The daily work overlaps. The legal difference is which federal program the employer belongs to: Medicare home health agencies and Medicare or Medicaid nursing homes must follow the federal training rules, while personal care agencies follow state rules only.
What each role does
Home health aide. A registered nurse or therapist assigns the aide to a patient with written care instructions. The duties in the rule are hands-on personal care, simple procedures as an extension of therapy or nursing, help with walking or exercises, and help with medications a patient would normally take alone (42 CFR 484.80(g)).
Personal care aide. Medicaid defines personal care services as care authorized by a physician's plan of treatment or a state-approved service plan, furnished in a home, by someone qualified under state rules who is not the client's family member (42 CFR 440.167). In practice: bathing, dressing, meals, light housekeeping and companionship.
Certified nursing assistant. The required curriculum describes the job: vital signs, bathing, grooming, dressing, toileting, feeding, skin care, transfers and positioning, care of residents with dementia, restorative care and residents' rights (42 CFR 483.152(b)). Most nursing assistants work in nursing and residential care facilities and in hospitals (BLS Occupational Outlook Handbook, August 27, 2026).
Training and certification, rule by rule
Home health aide. Classroom and supervised practical training must total at least 75 hours, with at least 16 classroom hours before at least 16 hours of supervised practical training (42 CFR 484.80(b)). A registered nurse runs the competency evaluation (42 CFR 484.80(c)). After 24 consecutive months without paid aide work you must complete a program again (42 CFR 484.80(a)(2)). A person in good standing on a state nurse aide registry also qualifies as a home health aide (42 CFR 484.80(a)(1)(iii)). Any organization may run an HHA program except an agency with recent compliance problems (42 CFR 484.80(f)), which is why many agencies train their own aides.
Certified nursing assistant. A state-approved program must run at least 75 clock hours with at least 16 hours of supervised practical training (42 CFR 483.152(a)). Before any direct contact with a resident, a trainee completes 16 hours on communication, infection control, safety and emergency procedures, promoting independence and residents' rights (42 CFR 483.152(b)(1)). The competency evaluation has two parts, a written or oral exam and a skills demonstration; you must pass both, and the state must allow at least three attempts (42 CFR 483.154). A pass goes on the state nurse aide registry within 30 days, and the state may not charge you to be listed (42 CFR 483.154(e) and 483.156(b)(4)). A nursing home must receive registry verification before letting you work as a nurse aide (42 CFR 483.35(d)(4)). Many states require more hours: Texas 100, Washington 108, Illinois and Arizona 120, California 160. The state table and the rule that bars nursing homes from charging employees for training are in free CNA training.
Personal care aide. No federal rule sets hours. When a home health agency furnishes Medicaid personal care, the aide "must meet all qualification standards established by the state" and "only needs to demonstrate competency in the services the individual is required to furnish" (42 CFR 484.80(i)). The hours, if any, come from your state Medicaid program or home care licensing agency. Several large agencies state that they hire with no experience and train on the job; their statements are in caregiver jobs with no experience. Check your state Medicaid agency's personal care rules and your state nurse aide registry before you count on a title transferring.
Pay by role in 13 metros
Home health aides and personal care aides share one BLS code, so their pay is reported together.
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| Metro | HHA and PCA median | HHA and PCA, 10th to 90th percentile | CNA median |
|---|---|---|---|
| Atlanta-Sandy Springs-Roswell, GA | $14.39 | $12.54 to $18.61 | $18.92 |
| Austin-Round Rock-San Marcos, TX | $13.64 | $11.00 to $17.75 | $18.53 |
| Boston-Cambridge-Newton, MA-NH | $19.67 | $17.70 to $22.79 | $22.88 |
| Chicago-Naperville-Elgin, IL-IN | $18.36 | $16.84 to $20.43 | $22.57 |
| Dallas-Fort Worth-Arlington, TX | $12.93 | $10.76 to $17.31 | $18.53 |
| Denver-Aurora-Centennial, CO | $18.70 | $17.86 to $22.22 | $23.61 |
| Houston-Pasadena-The Woodlands, TX | $11.27 | $10.69 to $15.35 | $18.26 |
| Los Angeles-Long Beach-Anaheim, CA | $16.50 | $16.50 to $18.28 | $22.78 |
| Miami-Fort Lauderdale-West Palm Beach, FL | $15.81 | $15.00 to $18.11 | $18.28 |
| New York-Newark-Jersey City, NY-NJ | $19.08 | $17.77 to $22.39 | $23.69 |
| Orlando-Kissimmee-Sanford, FL | $16.40 | $14.56 to $18.11 | $18.12 |
| Phoenix-Mesa-Chandler, AZ | $17.75 | $14.91 to $19.85 | $21.77 |
| Seattle-Tacoma-Bellevue, WA | $23.18 | $21.25 to $26.43 | $25.00 |
Source: BLS Occupational Employment and Wage Statistics, May 2025, hourly wages, SOC 31-1120 and 31-1131.
Nationally the gap is $3.11 an hour: $20.32 for nursing assistants against $17.21 for aides (BLS OEWS, May 2025). It is widest in Texas: $6.99 in Houston and $5.60 in Dallas-Fort Worth. In Boston it is $3.21. All 50 states for aides are in home health aide pay by state; other hourly jobs are compared in pay benchmarks.
Who hires each role
Home health and personal care aides held 4,677,100 jobs in 2025, with 18 percent growth projected through 2035 and about 760,500 openings a year (BLS Occupational Outlook Handbook, August 27, 2026). Nursing assistants and orderlies held 1,558,700 jobs, with 3 percent growth and about 203,300 openings a year (same source). In the first quarter of 2026, 91.3 percent of postings in personal care and home health were entry level, the highest share of any field Indeed measured (Indeed Hiring Lab, July 23, 2026).
- Home care agencies hire PCAs and HHAs. Help at Home states 49,000 caregivers in 12 states and "no experience required" (helpathome.com, October 2026). Visiting Angels lists nearly 600 offices and says prior experience "is optional for most entry-level positions" (visitingangels.com, October 2026).
- Medicare-certified home health and hospice agencies need aides who meet the 75-hour standard or are on the nurse aide registry (42 CFR 484.80(a)).
- Nursing homes hire CNAs and may not charge an employee for the training (42 CFR 483.152(c)). CMS puts the class at 4 to 12 weeks (CMS nursing home careers page, updated October 14, 2026).
- Hospitals hire nursing assistants, and some run paid classes; examples are in free CNA training.
Which one to start with
- Need income this month? A PCA or companion role starts fastest.
- Want a hospital or nursing home? Go straight to CNA; the registry listing moves with you between employers in the state.
- Want home visits with a Medicare agency? HHA training is the shortest formal program, and a CNA listing already qualifies you (42 CFR 484.80(a)(1)(iii)).
- Thinking about a clinic later? Medical assistants follow different rules; see medical assistant jobs without certification.
The whole field is mapped in the healthcare jobs guide.
Current openings
See healthcare jobs nationwide, or by city: Boston, Houston, New York.
More healthcare openings
Current source-linked listings could not be confirmed in this sample. Check the category search and each original posting for availability.
How to verify a listing
Every opening on JobPin links to its source posting. Open it, check the date, and read the training and certification lines before you apply. A nursing home that asks an employee to pay for its own nurse aide program is breaking the federal rule above; ask for the written terms. No legitimate employer charges a fee to apply, and none hires by text message before you apply.
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