HHA scope of practice: what a home health aide can and cannot do

These are the questions where every answer sounds like it helps the client. The test is whether you know which help belongs to the aide and which belongs to the nurse. The aide follows a care plan written by a registered nurse or therapist, does only tasks they were trained and found competent in, and reports anything beyond that.

Who writes the care planA registered nurse or other skilled professional such as a physical therapist. The aide follows it and never changes it
Within the roleBathing, dressing, grooming, toileting, transfers, range of motion as assigned, meals, light housekeeping, observing and reporting
MedicationsAssisting with self-administration as state law and the agency allow: reminding, bringing the labeled container. The client takes it
Outside the roleInjections, sterile procedures, inserting or reinserting catheters, deciding or changing doses
Doctor's ordersAn aide does not take verbal or telephone orders. Have the doctor contact the nurse
Diabetic foot careDo not cut or file the toenails of a client with diabetes or poor circulation; report the need
WoundsA simple, clean dressing only if assigned, trained and allowed by state law. Draining or surgical wounds go to the nurse
Medical adviceDo not advise on stopping, skipping or splitting medication. Report the side effect or question
Untrained taskTell the nurse and ask for training and supervision before doing it
Unsafe or unassigned taskDecline politely, explain, and notify the supervisor so the need is still met
RestraintsNever applied by an aide
DiagnosingAn aide describes what they observe and never names a diagnosis in the record

Where the point is lost: When two answers both look caring, ask which one a nurse would have to sign off on. Changing a wound dressing, accepting a doctor's new order, trimming a diabetic client's toenails or advising on a pill all need a licensed professional. So the tested answer is to explain kindly that it is outside the aide's role and call the nurse, often while also reporting the change that prompted the request.

HHA scope of practice: what a home health aide can and cannot do

6 questions on what HHAs cannot do, each with an explanation and statute citation.

6 questions

Pass line: 80%, same as the real exam

Questions and answers, explained

All 6 questions above, with the correct answer and why it is correct. Everything here is on hha scope of practice: what a home health aide can and cannot do.

  1. A client asks the aide to change the bandage over a surgical wound that is draining. What should the aide do?

    • AChange it using clean gloves and fresh gauze
    • BAsk a family member to change it instead
    • CExplain it is outside the aide's role and call the nurseCorrect
    • DLeave it alone and mention it to the nurse at the next visit

    Why: A draining surgical wound needs sterile or nurse-level care, which is outside a home health aide's scope. The aide explains this kindly and notifies the nurse right away, because new drainage is also a change that must be reported. Waiting until the next visit delays a report that may matter.

    Reference 42 CFR 484.80(b)(3); scope of practice

  2. The client's doctor calls the home while the aide is there and gives a new medication order. What should the aide do?

    • AWrite the order down and start it at the next dose
    • BAsk the doctor to call the nurse, or get the nurse on the lineCorrect
    • CTell the client's daughter to handle the new order
    • DRepeat the order back word for word so the doctor knows it was heard

    Why: Home health aides do not take verbal or telephone orders from doctors. The aide politely explains this and has the doctor contact the supervising nurse, then lets the nurse know about the call. Accepting the order, even by reading it back, would be acting outside the aide's role.

    Reference Scope of practice; agency policy

  3. The nurse assigns a task the aide was never trained to do. What should the aide do?

    • ATry it carefully and ask the client for feedback
    • BWatch a video online and then do the task
    • CTell the nurse and ask for training before doing itCorrect
    • DRefuse and say nothing more about it

    Why: An aide may only perform tasks for which competency has been shown. The safe and professional response is to tell the nurse honestly and ask for training and supervision first. Refusing silently leaves the client's need unmet and the nurse unaware.

    Reference 42 CFR 484.80(c), (g)

  4. A client asks the aide whether she should stop taking her blood pressure pill because it makes her dizzy. What should the aide say?

    • AYes, skipping a few doses is usually harmless
    • BTake half a pill each day until the dizziness goes away
    • CSwitch to a natural remedy that the aide uses
    • DReport the dizziness to the nurse, who will follow upCorrect

    Why: Advising on medication is outside the aide's role. Dizziness is a possible side effect and a fall risk, so the aide reports it promptly to the nurse, who contacts the doctor. Every other choice is giving medical advice.

    Reference Scope of practice

  5. Which task is generally within a home health aide's role?

    • AGiving an insulin injection the client cannot manage
    • BInserting a urinary catheter that fell out
    • CHelping the client bathe and dressCorrect
    • DDeciding to stop a medication that causes nausea

    Why: Personal care such as bathing, dressing, grooming and toileting is the core of the aide's role. Injections, catheter insertion and medication decisions require a licensed nurse or prescriber. If a catheter falls out or an injection is due, the aide calls the nurse.

    Reference 42 CFR 484.80(b)(3); scope of practice

  6. A client with diabetes asks the aide to trim her toenails, which are thick and long. What should the aide do?

    • ATrim them straight across with sharp clippers, then file the edges
    • BFile them short instead of cutting them
    • CNot trim them, and report the request to the nurseCorrect
    • DSoak the feet in hot water first, then trim

    Why: People with diabetes often have poor circulation and reduced sensation, so a small nick can become a serious infection. Aides do not cut or file the toenails of clients with diabetes or circulation problems; a nurse or podiatrist does. Hot soaks are also unsafe because the client may not feel a burn.

    Reference ADA foot care guidance; HHA scope of practice

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