No Training Budget? Train Your Aides for Free.
A complete, ready-to-use Home Health Aide course: 12 modules, quizzes with explanations, a final exam, and a certificate. No sign-up. No cost. Works on any phone.
Start the Free Training NowNo account needed · Progress saves on your device Send it to your team ↓Running a small agency? This probably sounds familiar.
- You need trained aides, but you can’t afford a training company or a full-time educator.
- Building your own course would take weeks you don’t have.
- New hires start with very different levels of knowledge.
- Your RN spends hours repeating the same basics to every new aide.
- Paper binders get lost, and you never know who actually read them.
Here is the truth: you don’t need a big budget to give your team solid training. You need a clear, complete course your aides can finish on their phones, and a simple way to see who passed.
Introducing the Free Home Health Aide Training Course
Built by a nurse practitioner who runs a licensed home care agency in Virginia and has cared for older adults since 2004. Everything your aides need to learn the basics is in one place, and it is 100% free.
Yes! Start the Free CourseWhat your aides learn
Why owners love it
- It saves your nurse’s time. Aides learn the basics on their own, so your nurse is not repeating them for every new hire.
- Aides can’t skip ahead. Each module unlocks only after they pass the one before it.
- Every answer is explained. Aides learn from their mistakes, not just get a score.
- It works on any phone. Aides can study on the bus, on breaks, or at home.
- Results come to you. When an aide passes, they can send their certificate details straight to you with one tap.
- Plain, simple language. Written for real caregivers, not textbook readers.
How to use it with your team
- Send the link. Share this page with new hires by text, WhatsApp, or email.
- They complete the 12 modules. Each module ends with a quiz they must pass.
- They pass the final exam. A certificate with their name, score, and certificate number appears.
- You get the results. They print the certificate or send the results straight to you.
This course is for you if…
- You run a small home care agency on a tight budget
- You need a simple way to teach new aides the basics
- You are a caregiver who wants to learn or refresh skills
- You are a family caregiver who wants to give safer care at home
It is NOT…
- A state license or certification
- A hands-on skills class
- Medical advice for a specific person
Questions people ask
Is it really free?
Yes. There is no cost, no sign-up, and no credit card. The whole course, quizzes, final exam, and certificate are free.
Do my aides need an account?
No. They enter their name and start. Progress is saved on the device they use, so they should finish on the same phone or computer.
How do I know an aide passed?
After the final exam, the aide can print the certificate or send their name, score, date, and certificate number to the agency.
Does this replace our skills checks?
No. This course teaches knowledge only. How your agency handles hands-on skills is up to you.
Can family caregivers use it?
Yes. Anyone who wants to learn safer caregiving is welcome.
Better-trained aides. Safer clients. Zero cost.
Your next new hire could start learning today, on their phone, before their first shift.
Start the Free Training NowNo account neededThis free course is for education only. It is not a license, certification, or medical advice. Each agency decides how to use it within its own program. Questions about your own health? Please talk with your own doctor. NOVA DMV Nurses and Caregivers LLC · 42882 Truro Parish Drive, Suite 206 #5, Ashburn VA 20148 · Tel 571-267-0620 · www.northernvirginianurses.com
🎁 Your Free Training Starts Below
Enter your full name, then begin Module 1. Pass each module to unlock the next.

Home Health Aide Training and Certificate of Completion
12 modules • Lessons, scenarios and videos • Quiz with explanations after every module • Final exam • Printable certificate
42882 Truro Parish Drive, Suite 206 #5, Ashburn, VA 20148
Phone: 571-267-0620 | Fax: 1-888-261-8833
www.northernvirginianurses.com
Welcome to Home Health Aide Training
This free course has 12 modules. Each module has lessons, real-life scenarios, video resources, and a 5-question knowledge check with an explanation for every answer. You must pass each module before the next one opens. After all 12 modules, the final exam opens. Pass the final exam to print your certificate of completion.
- Complete all 12 modules in order.
- Pass each module knowledge check with at least 80% (4 of 5).
- Pass the 30-question final exam with at least 80% (24 of 30).
- Print your certificate or send it to the agency after passing the final exam.
Before you begin
Enter your full name exactly as you want it printed on your certificate. Your progress is saved only in this browser on this device. Clearing your browser data or using another device will remove saved progress.
Module 1: The Home Health Aide Role, Scope of Practice and the Care Team
- Describe what a Home Health Aide (HHA) does and where the HHA fits on the care team.
- List tasks an HHA may do and tasks an HHA may not do.
- Explain what the plan of care is and why you must follow it.
- Know who to call and when.
What a Home Health Aide does
A Home Health Aide gives personal care and support to people in their own homes. Clients may be older adults, people living with disabilities, people recovering from surgery or illness, or people with long-term health conditions. The HHA helps the client stay safe, clean, comfortable, and as independent as possible. The HHA is also the “eyes and ears” of the care team, because the aide often sees the client more than anyone else.
The HHA works under the direction of a supervising Registered Nurse (RN) and follows the client’s written plan of care. The plan of care tells you what tasks to do, how often, and any special instructions such as diet, activity limits, or safety precautions.
The care team
- The client and family: the center of the team. The client’s goals and choices guide the care.
- Physician, nurse practitioner, or physician assistant: diagnoses illness and orders treatments and medicines.
- Registered Nurse (RN) supervisor: assesses the client, writes and updates the plan of care, trains and supervises aides, and is your first call for questions and changes.
- Licensed Practical Nurse (LPN): gives some skilled nursing care under RN direction.
- Therapists: physical, occupational, and speech therapists help with movement, daily living skills, swallowing, and speech.
- Case manager or service facilitator: coordinates services, authorizations, and community resources.
- Home Health Aide or Personal Care Aide: gives hands-on personal care, observes, and reports.
- Help with activities of daily living (ADLs): bathing, dressing, grooming, oral care, toileting, and eating.
- Help the client walk, move, and transfer, using equipment the aide has been trained on.
- Take and record routine vital signs, weight, and intake and output when directed.
- Simple, non-sterile dressing changes when the care plan and agency policy allow.
- Prepare meals that follow the ordered diet, and help with feeding.
- Remind the client to take medicines and observe whether they were taken.
- Light housekeeping related to the client’s care: laundry, dishes, tidying the client’s area.
- Companionship, reassurance, and encouragement.
- Observe, document, and report changes promptly.
- Give medicines: pills, injections, eye drops, inhalers, or IV medicines. Reminding is allowed; giving is not.
- Tube feedings, or adding anything to a feeding tube.
- Sterile procedures, including sterile wound care and inserting urinary catheters.
- Changing or suctioning a tracheostomy tube.
- Changing oxygen settings.
- Giving medical advice, diagnosing, or telling a client or family what a symptom means.
- Any task you have not been trained on, or that is not on the plan of care.
When you are asked to do something outside your role
Clients and families may ask you to do things that are not on the plan of care, such as giving a pill, changing an oxygen setting, or driving the client in your own car. Politely say that you are not allowed to, explain that you will call your supervisor, and then call the RN. This protects the client and you.
Video resources
Home Health Aide Training Overview
The role, purpose, and basic responsibilities of home health care staff.
The Role of a Home Health Aide
Respectful care, communication, and professional responsibilities.
Module 2: Client Rights, Privacy (HIPAA), Ethics and Professional Boundaries
- Describe the rights clients keep at home.
- Protect client privacy and health information.
- Keep professional boundaries with clients and families.
- Respond correctly when a client refuses care.
Client rights
Clients keep all of their civil and legal rights, no matter their age, illness, or memory problems. Home health clients have the right to:
- Be treated with dignity, courtesy, and respect, and have their property respected.
- Take part in planning their care and be told about their care in a way they understand.
- Refuse care or treatment.
- Privacy and confidentiality of their personal and health information.
- Be free from abuse, neglect, exploitation, and restraints that are not ordered.
- Voice complaints without being punished, and be told how to file a complaint.
- Practice their own religion and culture, and choose their own clothing, food, and routines when safe.
Privacy and dignity during care
- Knock, say who you are, and wait before entering a room.
- Explain what you are going to do before you do it, and ask permission.
- Close doors, curtains, and blinds. Cover the client with a towel or blanket and uncover only the part you are washing.
- Call the client by the name they prefer. Do not use pet names such as “honey” unless the client asks you to.
- Do not open mail, look through drawers, or use the client’s phone, food, or belongings for yourself.
Protecting health information (HIPAA)
HIPAA is the federal law that protects a person’s health information. Protected health information (PHI) includes the client’s name, address, diagnoses, medicines, and anything that could identify them along with their health.
- Share client information only with your supervisor and care team members who need it to care for the client.
- Never post about clients on social media, even without a name or face. Small details can identify a person.
- Do not talk about clients with neighbors, friends, your family, or other clients.
- Do not take photos of clients or their homes on your personal phone.
- Keep paper records out of sight and log out of electronic records and apps.
- If a family member asks about the client’s diagnosis or prognosis, kindly refer them to the RN supervisor.
Professional boundaries
A professional relationship is friendly and caring, but it exists to meet the client’s needs, not the aide’s. Boundary problems often start small.
- Accept tips, cash, gift cards, or personal gifts. Politely decline and tell your supervisor.
- Borrow or lend money, or sell anything to clients.
- Use a client’s bank card, checks, or online accounts unless the care plan clearly allows it.
- Bring friends, children, or pets to a client’s home.
- Share your personal problems, or give clients your personal phone number or social media.
- Sign legal papers, wills, or witness documents for a client.
- Have a romantic or sexual relationship with a client. This is never allowed.
When a client refuses care
A client with decision-making capacity has the right to say no, even to a bath or a meal. Never force or trick a client. Calmly ask why, explain the benefit, offer another time or another way, respect the answer, write it down, and tell the RN. Repeated refusals of food, fluids, or medicines are important changes to report.
Scenario: Keeping information private
You care for Mr. Davis, 82, who is recovering from a stroke. His daughter asks whether he will ever walk again. Later, a neighbor stops you outside and says, “I saw an ambulance here last week. Is Mr. Davis dying?”
- The daughter: Kindly explain that aides cannot discuss diagnosis or recovery outlook, and that the RN supervisor or case manager can answer her questions.
- The neighbor: Politely say you cannot share any information because privacy laws protect the client.
- Afterward: Write both conversations in your visit note and tell your RN supervisor.
Video resources
Professional Role and Boundaries
Professional behavior in the home-care setting.
Module 3: Abuse, Neglect, Exploitation and Mandated Reporting
- Recognize signs of abuse, neglect, and financial exploitation.
- Know your duty as a mandated reporter in Virginia.
- Report and document concerns correctly.
Types of abuse and warning signs
- Physical abuse: hitting, pushing, rough handling, or improper restraint. Signs: unexplained bruises (especially on the upper arms, chest, or back), burns, fractures, injuries in different stages of healing, or stories that do not match the injury.
- Emotional or psychological abuse: yelling, threats, humiliation, or isolating the client from friends and family. Signs: fear, withdrawal, anxiety around a certain person.
- Sexual abuse: any unwanted sexual contact. Signs: bruising in the genital area or inner thighs, torn or stained clothing, new infections, fear of a certain person.
- Neglect: failing to provide food, water, hygiene, medicines, supervision, or needed care. Signs: weight loss, dehydration, dirty clothing or bedding, pressure injuries, untreated health problems, unsafe living conditions.
- Self-neglect: a client who can no longer meet their own basic needs.
- Financial exploitation: misuse of the client’s money or property. Signs: missing money or belongings, unpaid bills, sudden changes to a will or bank account, new “friends” taking control of finances.
In Virginia, people who provide direct care to adults are mandated reporters (Code of Virginia § 63.2-1606). If you have reason to suspect abuse, neglect, or exploitation of an adult, a report must be made immediately to Adult Protective Services. Tell your RN supervisor right away. Your agency will help, and you may also report yourself.
Virginia Adult Protective Services hotline: 1-888-832-3858
Online report: dars.virginia.gov/aps/APSreport.htm
If someone is in danger right now: call 911.
What to do if you suspect abuse
- Make sure the client is safe. Call 911 if there is immediate danger.
- Do not investigate, accuse, or confront anyone.
- Do not promise the client you will keep it secret. Kindly explain that you must tell people who can help.
- Report to your RN supervisor right away, and make sure a report reaches Adult Protective Services.
- Document exactly what you saw and heard: date, time, location, size and color of injuries, who was present, and the client’s own words in quotation marks.
Restraints
A restraint is anything that limits a person’s freedom of movement, such as tying a person to a chair, tucking sheets so tightly they cannot get up, or locking them in a room. Aides must never use restraints. If a family member uses one, report it to the RN.
Video resources
Client Safety and Advocacy
Protection and safety awareness.
Module 4: Communication, Aging, Dementia and Changes to Report
- Communicate respectfully with clients, families, and the care team.
- Tell normal aging changes from warning signs.
- Support clients living with dementia.
- Know which changes to report right away.
Good communication
- Use the client’s preferred name. Face them, make eye contact if culturally comfortable, and smile.
- Speak clearly and calmly. Do not shout. Lower your pitch if the client has hearing loss.
- Give one instruction at a time and allow extra time to respond.
- Use simple, yes-or-no questions when a client has trouble speaking.
- Check that hearing aids and glasses are clean, on, and working.
- Listen more than you talk. Let the client finish.
- Use a qualified interpreter, not children, for clients who speak another language, following agency policy.
- Respect cultural and religious practices, such as modesty during bathing, food rules, and prayer times.
Normal changes with aging
Aging may bring slower movement, less muscle strength, thinner and drier skin, poorer vision up close, hearing loss, lighter sleep, slower thinking, less thirst, and constipation. These are gradual changes.
Dementia
Dementia is a group of brain diseases, such as Alzheimer disease, that slowly cause memory loss, confusion, and trouble with daily tasks. People with dementia may repeat questions, get lost, misplace items, or become anxious or upset, especially late in the day (sometimes called “sundowning”).
- Keep a calm, simple routine. Do tasks the same way and at the same time each day.
- Approach from the front, say your name, and explain each step.
- Do not argue or correct. Redirect gently to another topic or activity.
- Break tasks into small steps. Lay out clothes in the order they go on.
- Look for causes of behavior changes: pain, hunger, thirst, needing the toilet, being too hot or cold, noise, or infection.
- Keep the home safe: lock away medicines, chemicals, and sharp items; watch for wandering.
Delirium
Delirium is sudden confusion that develops over hours or days. It is often caused by infection (such as a urinary tract infection), dehydration, new medicines, or pain. It is a medical emergency. Report sudden confusion to the RN right away, even in a client who already has dementia.
Changes that must be reported right away
- Sudden confusion, unusual sleepiness, or a change in behavior.
- Stroke signs: face drooping, arm or leg weakness, slurred speech, loss of balance, vision changes. Call 911.
- Chest pain, trouble breathing, blue or gray lips, or fainting. Call 911.
- Fever, chills, a new cough, painful or bloody urination, little or no urine, or new incontinence.
- New pain, falls, injuries, bruises, or skin breakdown.
- Not eating or drinking, vomiting, diarrhea, or blood in stool or vomit.
- Swelling in the legs, sudden weight gain, or shortness of breath when lying flat.
- Refusing care, medicines, food, or fluids.
Video resources
Understanding Aging in Home Care
Changes that may affect daily care.
Respectful Client Communication
Calm, supportive communication during care.
Module 5: Infection Prevention and Standard Precautions
- Explain how infections spread.
- Perform hand hygiene correctly.
- Put on and take off personal protective equipment (PPE) in the right order.
- Handle laundry, sharps, and spills safely.
How infections spread (the chain of infection)
Germs spread when they pass from a source (a person, body fluid, or surface) through a way out (cough, wound, stool), by a way of travel (hands, air, objects), through a way in (mouth, nose, cuts, catheters), to a person who can get sick. Older adults and people with chronic illness get infections more easily. Breaking any link stops the spread, and clean hands break the most links.
Standard precautions
Standard precautions are used with every client, every time, whether or not you know they have an infection. Treat all blood, body fluids, broken skin, and mucous membranes as possibly infectious.
- Wet hands with clean running water and apply soap.
- Rub hands together and scrub for at least 20 seconds: palms, backs of hands, between fingers, thumbs, under nails, and wrists.
- Rinse with fingertips pointing down.
- Dry with a clean paper towel, and use the towel to turn off the faucet.
Alcohol-based hand rub (at least 60% alcohol) is fine when hands are not visibly dirty. Use soap and water when hands are visibly soiled, after using the toilet, before eating or preparing food, and when caring for a client with diarrhea such as C. difficile, because hand rub does not kill those germs well.
When to clean your hands: when you arrive and before you leave; before and after touching the client; before clean tasks such as mouth care or meals; after touching body fluids; after removing gloves; after touching the client’s surroundings; and before and after eating.
Personal protective equipment (PPE)
- Gloves: when you may touch blood, body fluids, mucous membranes, broken skin, or soiled items. Change gloves between tasks and clean your hands after removing them. Gloves never replace hand hygiene.
- Gown: when clothing may be splashed or soiled.
- Mask and eye protection: when splashes or sprays are possible, or for respiratory illness per agency policy.
Other safe practices
- Carry soiled linen away from your uniform. Do not shake it. Wash it per the care plan.
- Never recap needles. Clients’ used sharps go in a hard, puncture-proof container. Tell the RN if needles are left out.
- Clean spills of blood or body fluids with gloves and an approved disinfectant.
- Cover your cough and stay home when you have a fever, vomiting, or diarrhea. Tell your supervisor.
- Keep your vaccines up to date, including the yearly flu shot, per agency policy.
- Report signs of infection: fever, chills, redness, swelling, drainage, cloudy or foul urine, new cough, or new confusion.
Video resources
Hand Hygiene and Infection Prevention
Basic infection-control actions used during client care.
Module 6: Vital Signs, Observation and Measurement
- Measure temperature, pulse, breathing, and blood pressure correctly.
- Know usual adult ranges and when to report.
- Measure weight, pain, and intake and output.
Take vital signs only if you are trained and the care plan directs it. Use working equipment, follow the care plan’s reporting rules, and compare readings to the client’s usual numbers. A big change from the client’s normal matters even if the number is in the usual range.
| Vital sign | Usual adult range | Report to the RN right away if |
|---|---|---|
| Temperature (oral) | About 97.6°F to 99.6°F (36.4°C to 37.5°C) | 100.4°F (38°C) or higher, or much lower than usual |
| Pulse | 60 to 100 beats per minute | Below 60 or above 100, or irregular when new |
| Breathing | 12 to 20 breaths per minute | Below 12 or above 20, or trouble breathing |
| Blood pressure | Normal is below 120/80 | Outside the care plan’s limits (for example, top number above 140 or below 90) |
| Oxygen saturation (if ordered) | Usually 95% or higher | Below the care plan’s number (often below 90 to 92%) |
Temperature
- Oral: wait 15 to 20 minutes after the client eats, drinks, or smokes. Place under the tongue with lips closed.
- Other methods (ear, forehead, armpit) follow the device instructions. Armpit readings are usually lower.
- Older adults may have a serious infection with only a small fever or none at all. Report new confusion or weakness too.
Pulse and breathing (skills checklist)
| Step | What to do |
|---|---|
| 1 | Clean your hands, introduce yourself, and explain what you will do. |
| 2 | Rest the arm comfortably. Find the radial pulse on the thumb side of the wrist with the tips of two or three fingers. Never use your thumb, because it has its own pulse. |
| 3 | Count for 60 full seconds. Note whether it is regular, strong, or weak. |
| 4 | Keep your fingers on the wrist and count breaths for 60 seconds without telling the client, because people change their breathing when they know it is being counted. |
| 5 | Clean your hands and record the numbers right away. |
| 6 | Report a pulse below 60 or above 100, or breathing below 12 or above 20, to the RN. |
Blood pressure
- Have the client sit quietly for 5 minutes with feet flat and back supported.
- Use the right cuff size. A cuff that is too small reads falsely high.
- Support the arm at heart level. Place the cuff on bare skin.
- Do not take blood pressure on an arm with a dialysis access, IV, injury, or on the side of a mastectomy, unless the care plan says it is allowed.
Pain
Pain is what the client says it is. Ask the client to rate pain from 0 (no pain) to 10 (worst pain). For clients who cannot speak, watch for grimacing, moaning, guarding a body part, restlessness, or changes in behavior. Report new or worse pain.
Weight and intake and output
- Weigh at the same time of day, on the same scale, in similar clothing. Report sudden weight gain (for example, 2 to 3 pounds in a day or 5 pounds in a week in a client with heart failure, or the amount in the care plan).
- 1 ounce = 30 mL. An 8-ounce cup = 240 mL.
- Measure urine in a marked container. Record amounts, color, and odor. Report dark, bloody, or very small amounts of urine.
Video resources
Taking Vital Signs
Temperature, pulse, respirations, and observation basics.
Module 7: Personal Care and Hygiene
- Give bathing, perineal care, oral care, grooming, and dressing help safely and with dignity.
- Help with toileting and incontinence care.
- Care for a client with a urinary catheter within the HHA role.
Before any personal care
- Check the care plan. Gather supplies first so you never leave the client alone in the tub or on the toilet.
- Clean your hands, explain the task, and ask permission.
- Provide privacy and warmth. Keep the client covered except for the area being washed.
- Let the client do as much as safely possible. Independence keeps strength and self-esteem.
Bathing
- Check water temperature with your inner wrist or a bath thermometer (about 100°F to 105°F, or as your agency directs) before it touches the client. Older adults and people with diabetes or nerve damage may not feel heat and can be burned.
- Wash from the cleanest area to the dirtiest: eyes and face first (no soap on the eyes; wipe from the inner corner outward), then arms, chest, belly, legs, back, and perineal area last.
- Change bath water if it becomes cool, soapy, or dirty, and always after perineal care.
- Dry well, especially between toes and in skin folds, to prevent breakdown and fungal infections.
- Use a shower chair, grab bars, and non-slip mats as the care plan directs. Never leave a client alone in the tub or shower.
- Look at the skin from head to toe during every bath and report redness, rashes, bruises, cuts, or open areas.
Perineal care
- Wear gloves. Wash from front to back (clean area to dirty area) to help prevent urinary tract infections.
- Use a clean area of the washcloth for each stroke.
- For male clients, if uncircumcised, gently pull back the foreskin to clean, then return it to its normal position to prevent swelling.
- Report redness, sores, discharge, odor, or bleeding.
Oral care
- Brush teeth at least twice a day with a soft brush, including the tongue and gums.
- Dentures: handle over a towel or a sink of water so they do not break. Clean with a denture brush and cool water (hot water can warp them). Store in a labeled cup with water or solution.
- For clients who cannot swallow well, follow the care plan for mouth care, keep the head raised, and use very little water.
- Report bleeding gums, mouth sores, loose teeth, or poorly fitting dentures.
Grooming
- Shave with an electric razor for clients on blood thinners.
- Do not cut toenails or fingernails of clients with diabetes or poor circulation unless the care plan and agency policy allow it. Report long, thick, or ingrown nails.
- Help with hair care and make-up according to the client’s preferences.
Dressing
- Let the client choose clothing when possible.
- Dress the weak or affected side first. Undress the strong side first.
- Use clothing with large buttons, Velcro, or elastic waists if dressing is hard. Use non-skid shoes or slippers.
Toileting and incontinence
- Offer the toilet on a regular schedule, such as after meals and before bed.
- Answer requests quickly. Waiting causes accidents and falls.
- Change wet or soiled briefs right away. Clean and dry the skin and use barrier cream as the care plan directs.
- Report changes in urine or stool: color, amount, odor, blood, pain, constipation (no bowel movement in 3 days or per the care plan), or diarrhea.
Urinary catheter care (within the HHA role)
- Keep the drainage bag below the level of the bladder at all times, and off the floor.
- Keep the tubing free of kinks and loops. Secure the tubing to the thigh to prevent pulling.
- Do not disconnect the catheter from the tubing. Never insert or remove a catheter.
- Clean around the catheter with soap and water as directed.
- Empty the bag as directed, measure the urine, and record it.
- Report urine that is cloudy, bloody, foul-smelling, or very little; leaking; pain; or fever.
Video resources
Personal Hygiene and Bathing Assistance
Respectful hygiene and personal-care techniques.
Module 8: Skin Integrity and Pressure Injury Prevention
- Explain how pressure injuries develop and who is at risk.
- Check skin and report early warning signs.
- Reposition clients to protect their skin.
What is a pressure injury?
A pressure injury (also called a bed sore or pressure ulcer) is damage to skin and the tissue under it, caused by pressure that lasts too long, often over a bony area. Pressure squeezes blood vessels, so the tissue does not get enough oxygen. Friction (rubbing) and shear (skin sliding while the body moves the other way, such as sliding down in bed) make it worse.
Who is at risk?
Clients who stay in bed or a chair, cannot move themselves, are incontinent, are thin or poorly nourished, are dehydrated, have diabetes or poor circulation, or have reduced feeling or confusion.
Where to look
Check bony areas at every visit: back of the head, ears, shoulder blades, elbows, spine, tailbone (sacrum), hips, knees, ankles, and heels. Also check under medical devices such as oxygen tubing, braces, and catheters.
- Reposition bed-bound clients at least every 2 hours, or as the care plan says.
- Clients sitting in a chair should shift their weight often, and be repositioned at least every hour, or as the care plan says.
- Use a 30-degree side-lying tilt with pillows behind the back and between the knees, instead of lying directly on the hip.
- Float the heels off the bed with a pillow under the calves, as directed.
- Keep the head of the bed at 30 degrees or lower when possible to reduce sliding and shear, unless eating or the care plan says otherwise.
- Use a lift sheet to move the client. Never drag the client across the sheets.
- Keep skin clean and dry. Change wet linens and briefs right away.
- Keep sheets smooth and free of crumbs and wrinkles.
- Encourage food and fluids as the diet allows. Report poor appetite or weight loss.
- Never massage red areas over bones. Massage can damage tissue further.
Skin tears
Older skin is thin and can tear easily. Use lift sheets, pad bed rails and wheelchair parts, keep nails short, avoid tape on fragile skin, and support arms and legs when moving the client. Report any skin tear.
Scenario: A red area on the skin
Mrs. Gable, 88, weighs 170 pounds and stays in bed. During her bed bath you find a 2-inch dark red area over her tailbone. When you press lightly, it stays red. She says it burns when she lies on her back.
- What it means: Redness that does not fade when pressed can be the first stage of a pressure injury. Pressure must come off the area now.
- Right away: Turn her off her back into a slight side tilt (about 30 degrees) with pillows behind her hips and back. Do not rub or massage the area.
- Report: Call the RN supervisor promptly so the nurse can assess and update the care plan.
Video resources
Safe Repositioning Principles
Movement and positioning that support safety.
Module 9: Body Mechanics, Mobility, Transfers and Fall Prevention
- Use body mechanics that protect your back.
- Help clients walk and transfer safely with a gait belt, cane, walker, or wheelchair.
- Prevent falls and respond correctly if a client falls.
Body mechanics
- Stand with feet shoulder-width apart for a wide, stable base.
- Bend at the hips and knees, not the waist. Keep your back straight.
- Hold the load close to your body. Lift with your leg muscles.
- Turn by pivoting your feet. Do not twist your spine.
- Raise the bed to a comfortable working height when giving care, then lower it when you finish.
- Push or pull rather than lift when possible. Get help for heavy or dependent clients.
Transfers
- Check the care plan for how much help the client needs and which equipment to use.
- Explain each step and let the client help as much as they can. Count together (“1, 2, 3, stand”).
- Lock the wheels on beds and wheelchairs. Move footrests out of the way.
- Have the client wear non-skid shoes.
- Place the chair or wheelchair on the client’s strong side, close to the bed.
- Apply the gait belt snugly around the waist over clothing (you should fit two fingers under it). Hold it with an underhand grip.
- Never pull on the client’s arms, shoulders, or neck, and never let the client hold your neck.
- Use a mechanical lift only if you are trained and the care plan says so. Many lifts require two people.
- If the client gets dizzy, have them sit back down. Report dizziness and low blood pressure when standing.
Walking aids
- Cane: held on the client’s strong side. The cane moves forward with the weak leg.
- Walker: the client moves the walker forward, then steps into it. They should not carry the walker or climb stairs with it.
- Wheelchair: lock both brakes before transfers. Go backward down ramps and over curbs as trained.
- When walking with a client, stand slightly behind and to the weak side, holding the gait belt.
Range of motion
Range-of-motion exercises keep joints flexible. Do them only as the care plan and therapist direct. Move each joint gently and slowly. Stop if the client has pain, and report it. Do not exercise the neck unless specifically ordered.
Fall prevention
Falls are the leading cause of injury death among adults age 65 and older (CDC). Common causes include weakness, poor balance, dizziness, poor vision, certain medicines, rushing to the toilet, clutter, and poor lighting.
- Keep walkways clear of rugs, cords, and clutter. Wipe spills right away.
- Keep night lights on, and light switches and the phone within reach.
- Keep items the client needs, including the walker or cane, within reach.
- Offer toileting on a schedule so the client does not rush.
- Encourage sturdy, non-skid shoes, not socks or loose slippers.
- Report new dizziness, weakness, confusion, or near-falls.
If a client begins to fall
- Do not try to catch or hold up the client’s full weight.
- Widen your stance, hold the gait belt, pull the client close, and slowly ease them to the floor, protecting the head.
- Stay with the client. Do not get them up. Check for injury and call for help.
- Call 911 for head injury, severe pain, bleeding, inability to move, or if the client is on blood thinners and hit their head (follow agency policy).
- Notify the RN right away, and document what happened, what you saw, and who you notified.
Video resources
Safe Patient Handling and Transfers
Safe positioning, assistance, and transfer principles.
Body Mechanics and Fall Prevention
Injury prevention for the client and caregiver.
Module 10: Nutrition, Hydration, Food Safety and Swallowing Safety
- Follow ordered diets and client food preferences.
- Prevent choking and aspiration.
- Store and prepare food safely.
- Measure and record food and fluid intake.
Nutrition and hydration
Good nutrition helps clients heal, fight infection, keep their skin healthy, and stay strong. Older adults often feel less thirst, so offer fluids often unless the client has a fluid restriction. Signs of dehydration include dark urine, dry mouth, dizziness, confusion, and constipation. Report them.
Common therapeutic diets
- Low sodium (salt): for high blood pressure, heart failure, or kidney disease. Avoid adding salt and limit canned soups, deli meats, and processed foods.
- Carbohydrate-controlled (diabetic): regular meal times and controlled portions of starches and sweets.
- Fluid restriction: for some heart or kidney conditions. Measure and record all fluids, including ice, soup, and gelatin.
- Mechanical soft or pureed: for chewing or swallowing problems.
- Thickened liquids: only as ordered, at the ordered thickness.
- Allergies and cultural or religious food rules: always respected.
Never change a diet, food texture, or fluid limit on your own. Ask the RN if you are unsure.
Swallowing safety (dysphagia)
- Sit the client fully upright (90 degrees) for meals and for at least 30 minutes afterward.
- Offer small bites and sips. Let the client chew and swallow fully before the next bite. Never rush.
- Sit at eye level when feeding. Use a spoon, not a fork, to help a client eat.
- Stop feeding and tell the RN if the client coughs, chokes, has a wet or gurgly voice, holds food in the cheeks, or has trouble breathing.
- Do not use straws unless the care plan allows them.
Food safety
- Clean your hands and work surfaces before preparing food.
- Keep raw meat away from ready-to-eat foods. Use separate cutting boards.
- Keep the refrigerator at 40°F or below and the freezer at 0°F.
- Refrigerate leftovers within 2 hours (within 1 hour if it is above 90°F).
- Cook poultry to 165°F, ground meat to 160°F, and whole cuts of beef or pork to 145°F with a rest time.
- Check expiration dates. Throw out food that smells, looks, or tastes spoiled.
Measuring intake
Record what the client eats as a percentage of the meal (for example, “ate 50% of lunch”) and fluids in milliliters. 1 ounce = 30 mL, so 8 ounces = 240 mL.
Video resources
Nutrition and Meal Preparation
Meal support and nutrition in home care.
Food Safety and Dietary Restrictions
Safe food handling and diet considerations.
Module 11: Home Safety, Oxygen Safety, Emergencies and Basic First Aid
- Spot and fix common home hazards.
- Use oxygen safely.
- Respond to fire and medical emergencies.
- Give basic first aid within your training.
Home safety
- Clear walkways. Remove or tape down loose rugs. Keep cords against walls.
- Make sure there is good lighting in halls, stairs, and bathrooms.
- Check that smoke and carbon monoxide detectors work. Report broken ones.
- Store medicines and cleaning products in their original, labeled containers, away from food. Never mix cleaners such as bleach and ammonia.
- Keep emergency numbers, the client’s address, and the agency’s number posted near the phone.
- Know the exits. Have a plan for clients who cannot walk.
- Report pests, broken equipment, no heat or air conditioning in extreme weather, or unsafe living conditions.
Oxygen safety
- Oxygen makes fires start more easily and burn faster and hotter.
- NO SMOKING by anyone near oxygen. Post “No Smoking” signs.
- Keep oxygen away from open flames, candles, gas stoves, fireplaces, space heaters, and sparks.
- Do not use petroleum-based products (such as petroleum jelly) on the face or lips of a client on oxygen; use water-based products.
- Keep tanks upright and secured so they cannot fall.
- You may check that tubing is not kinked and the cannula is in place. You may NOT change the flow rate. If the setting looks wrong, call the RN right away.
Fire safety
If there is a fire, remember RACE: Rescue the client from danger, Alarm (call 911), Contain the fire by closing doors, Extinguish if small and safe, or evacuate.
To use a fire extinguisher, remember PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.
Grease fire on the stove: never pour water on it. If it is very small and you can do it safely, turn off the heat and cover the pan with a lid. Otherwise get the client out and call 911.
Medical emergencies
Call 911 first for life-threatening emergencies, stay with the client, then notify the RN. Follow the client’s advance directive or DNR order as your agency directs.
- Chest pain, trouble breathing, or unresponsiveness: call 911. Start CPR only if you are trained and it is consistent with the client’s wishes.
- Stroke (BE FAST): Balance loss, Eyes (vision change), Face drooping, Arm weakness, Speech difficulty, Time to call 911. Note the time symptoms started.
- Choking: if the client can cough or talk, encourage coughing. If they cannot breathe, cough, or speak, call 911 and give abdominal thrusts if you are trained.
- Seizure: protect the head, move objects away, loosen tight clothing, and time it. Never put anything in the mouth or hold the person down. After it stops, turn them on their side. Call 911 if it lasts more than 5 minutes, repeats, or the person is injured or does not wake up.
- Low blood sugar (shaky, sweaty, confused, pale): if the client is awake and can swallow and the care plan allows, offer juice or a fast sugar source, then call the RN. If the client cannot swallow or is unresponsive, call 911.
- Bleeding: wear gloves and press firmly on the wound with a clean cloth. Do not remove soaked cloths; add more on top. Call 911 for heavy bleeding.
- Burns: cool small burns with cool running water for 10 to 20 minutes. Never use ice, butter, or grease. Do not pop blisters. Report all burns.
Emergency preparedness
Help the client keep a basic emergency kit: water, non-perishable food, medicines list, flashlight, batteries, and copies of important papers. Know the agency’s plan for snowstorms, power outages, and heat waves.
Video resources
Emergency Recognition and Response
Warning signs and immediate safety actions.
Creating a Safe Home Environment
Practical steps for safer daily care.
Home Safety and Fall Prevention
Preventable fall and injury hazards in the home.
Module 12: Documentation, EVV, End-of-Life Care and Professional Practice
- Write clear, objective visit notes.
- Use Electronic Visit Verification (EVV) correctly.
- Give comfort care at the end of life.
- Manage your time, stress, and professional conduct.
Why documentation matters
Your notes tell the care team what care was given and what you observed. They are legal records and support billing. If it was not documented, it is treated as not done.
- Write promptly, during or right after the visit.
- Write facts you saw, heard, measured, or did. Avoid opinions and labels.
- Use exact amounts, times, and the client’s own words in quotation marks.
- Use only agency-approved abbreviations.
- Document only care you gave yourself. Never document ahead of time or for someone else.
- Correct paper errors with a single line, your initials, and the date, per agency policy. Never use correction fluid or erase.
- Report urgent concerns by phone first. Documentation does not replace calling.
| Avoid (opinion) | Write instead (fact) |
|---|---|
| “Client ate poorly.” | “Client ate 25% of lunch and drank 120 mL water.” |
| “Client was difficult.” | “Client refused shower at 0900, stated ‘I am too tired.’ Offered sponge bath; client accepted at 1000.” |
| “Skin looks bad.” | “Observed 2 cm red area on right heel that did not fade when pressed. RN notified at 1035.” |
Electronic Visit Verification (EVV)
The federal 21st Century Cures Act requires state Medicaid programs, including Virginia’s, to use EVV for personal care and home health services. EVV records who gave the care, who received it, the date, the location, the type of service, and the start and end times. Clock in and out yourself, at the client’s home, using the agency’s approved app or phone method. Never clock in for another worker, and never let someone clock in for you. Report missed or incorrect clock-ins to your supervisor right away. False time records can be Medicaid fraud.
End-of-life comfort care
- Follow the care plan and the client’s wishes, including any DNR order or hospice plan.
- Keep the client clean, dry, and comfortable. Reposition gently. Give mouth care often and keep lips moist.
- Do not force food or fluids. Appetite naturally decreases near the end of life.
- Hearing may remain even when the client cannot respond. Speak kindly and tell them what you are doing.
- Report pain, restlessness, breathing changes, or new symptoms to the RN or hospice nurse.
- Respect the family’s cultural and religious practices. Offer support and give them privacy.
Time management and self-care
- Arrive on time. Call your supervisor before your shift if you will be late or absent. Never leave a client without coverage.
- Plan your visit: review the care plan, gather supplies, and do the most important tasks first.
- Protect your own health: sleep, eat well, use body mechanics, and take breaks per policy.
- Caregiving can be stressful. Talk with your supervisor if you feel overwhelmed. Never take frustration out on a client.
- Your safety matters. If you feel unsafe in a home (violence, weapons, threats, drug use), leave and call your supervisor or 911.
Professional conduct
- Dress neatly, wear your ID badge, keep nails short, and follow the agency dress code.
- Do not use your personal phone for personal calls or social media during care.
- Never work under the influence of alcohol or drugs.
- Keep learning and keep your skills current.
Video resources
Observation, Reporting and Care Notes
Observing and reporting client changes.
Final Exam
Course Completion Certificate
Certificate of Completion
This certifies that
has successfully completed the 12-module Home Health Aide Training Program and earned a passing score of 80% or higher on the final knowledge exam.
Your name, score, date, and certificate number are filled in for you. Add your email and phone number, then press the button to send your results to the agency. You do not need to print and bring your certificate.
Educational use only. This free course gives general information about home health aide care. It is not a license and is not medical advice. Always follow the client’s plan of care and your RN supervisor’s instructions. If you have questions about your own health, please talk with your own doctor or health care provider. NOVA DMV Nurses and Caregivers LLC is not responsible for decisions made using this material.