To become a home health aide, you typically need a high school diploma or equivalent, though some jobs don't ask for one. If you'll work for a Medicare-certified home health agency, federal rules require at least 75 hours of classroom and supervised practical training and a passed competency evaluation before you can work. Some states also require a licence or certification.
Home health aides held about 4.7 million US jobs in 2025, BLS expects that to grow 18% in a decade, and you'll be working in weeks rather than years. The part most guides skip is the federal training rule, which is what decides whether you can work for the agencies that bill Medicare. I read the US Bureau of Labor Statistics (BLS) handbook and the federal regulation itself, 42 CFR 484.80, in October 2026.
The federal training rule in plain English
BLS says aides at certified home health or hospice agencies must complete formal training and pass a standardized test. The regulation spells out what that means:
| Requirement | What 42 CFR 484.80 says |
|---|---|
| Total training | Classroom and supervised practical training must total at least 75 hours |
| Order | At least 16 hours of classroom training must come before at least 16 hours of supervised practical training |
| Supervision | Practical training is under a registered nurse, or a licensed practical nurse supervised by a registered nurse |
| Competency test | You can only provide services for the agency after passing a competency evaluation |
| Ongoing training | At least 12 hours of in-service training in every 12-month period |
| Gaps in work | A continuous 24 consecutive months without paid aide work means you must complete another program |
That last row catches people out. If you qualify, then take two years away from paid aide work, your training won't count any more and you'll need to redo it.
How to become a home health aide, step by step
- Check what your state requires. BLS says some states require home health aides to hold a licence or certification, which may involve training, a background check and a competency exam. Your state board of health has the rules.
- Pick a training program. Postsecondary nondegree programs run at community colleges and vocational schools, and some employers train on the job.
- Learn the core skills. The federal list covers communication, recording temperature, pulse and respiration, infection prevention, personal hygiene tasks such as bed baths and oral care, safe transfers, range of motion, nutrition and spotting skin changes.
- Pass the competency evaluation. Some skills must be shown by observation. Under the rule, an unsatisfactory rating in more than one required area means you haven't passed.
- Add first aid and CPR. BLS says aides may be required to hold both.
Private agencies that don't receive federal funds can have their own rules that vary by state, so the 75 hours is the federal floor for certified agencies, not a universal number.
What home health aides earn
As of October 2026, BLS gives a median annual wage of $35,800 for home health and personal care aides in May 2025. The lowest 10% earned less than $27,040 and the highest 10% more than $45,040. Where you work shifts the number:
| Industry (US, May 2025) | Median annual wage | Share of jobs (%) |
|---|---|---|
| Residential intellectual and developmental disability facilities | $37,340 | 6 |
| Continuing care retirement communities and assisted living facilities for the elderly | $37,060 | 6 |
| Home healthcare services | $36,230 | 23 |
| Individual and family services | $34,900 | 51 |
Here's the detail worth knowing: the biggest employer, individual and family services with 51% of jobs, pays the least of the top four. Residential disability facilities and assisted living pay a little more, so it's worth applying beyond the agencies that advertise most.
What the work is like
Many aides work in clients' homes, while others work in group homes or care communities. Some stay with one client long term, others see several, and aides sometimes work in shifts so a client always has someone there. Most aides work full time, part-time work is common, and evening and weekend hours depend on clients' needs. Under the direction of a nurse, an aide may be allowed to give a client medication.
The qualities that make a good aide
BLS lists five, and they're the ones agencies test for at interview:
- Detail: following specific rules and protocols, such as instructions on how to care for wounds
- Emotional skills: being sensitive to clients who are in pain or distress
- Integrity: being dependable and trustworthy, and respectful during personal care such as bathing
- Interpersonal skills: listening closely and passing information on clearly to clients and other healthcare workers
- Physical stamina: being on your feet for many hours and lifting or turning clients
Outlook
BLS projects employment to grow 18% from 2025 to 2035, much faster than average, with about 760,500 openings a year. Aides held about 4.7 million jobs in 2025. The reason is simple: more older people want care at home, and long-term care is shifting from nursing homes to home- and community-based settings.
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Where it leads
Home health work is a common first step into healthcare. If you want more clinical work, my guide on how to become a CNA explains the nursing assistant route, and how to become a nurse covers the full nursing path.
My verdict
You can start this job quickly, and demand isn't going anywhere. That's rare in healthcare. If you want the widest choice of employers, train through a program that meets the federal 75-hour standard and pass the competency evaluation, because that opens the Medicare-certified agencies. Then keep working regularly, as a two-year gap wipes out your training and you'd be starting again.
Readers outside the US will want the UK and Australian support worker guide.
Frequently asked questions
How many hours of training does a home health aide need?
For Medicare-certified home health agencies, 42 CFR 484.80 requires at least 75 hours of classroom and supervised practical training, including at least 16 hours of each.
Do home health aides need a license?
It depends on the state. BLS says some states require a licence or certification, which may involve training, a background check and a competency exam.
How much do home health aides make?
As of October 2026, BLS gives a median annual wage of $35,800 for home health and personal care aides (May 2025 data).
What happens if a home health aide stops working for two years?
Under 42 CFR 484.80, a continuous period of 24 consecutive months without paid aide work means you must complete another training program before providing services.
Do home health aides need ongoing training?
Yes, at certified agencies. The federal rule requires at least 12 hours of in-service training in every 12-month period.
