Home Health Aides and Personal Care Assistants: Scope of Practice Regulations and Their Impact on Care

June 27, 2019

By 2030, California’s senior population will double to 9 million, but the state faces an estimated shortage of 200,000 home health and home care aides. To exacerbate the problem, California’s home health and home care aides are underutilized because of some of the most restrictive scope of practice laws in the country.

This brief is one of a series that examines California regulations of health professions, how the state’s regulations compare with those of other states, and what evidence exists to guide changes in health profession regulations. It provides an overview of home health and home care aides’ roles, including scope of work, educational requirements and scope of practice regulations for these workers in California compared with other states.

This document also summarizes the research on the impact of scope of practice regulations on access to care, care quality, and costs. Finally, the California home workforce – predominantly female and one-third immigrant – is described, including demographic characteristics, practice settings, and geographic distribution.

Key findings include:

The aging of California’s population will lead to a substantial increase in the need for home health and home care aides. The small body of research on scope of practice related to these workers indicates that home health aides and home care aides are capable of taking on more responsibility and can fulfill nurse-delegated tasks.

Constraints on the scope of practice of home health and home care aides results in their underutilization in the long-term care workforce. To date, there is no evidence that restricting such delegation benefits consumers and there is some evidence that permitting the delegation of more tasks would reduce unnecessary duplication of tasks and home visits by registered nurses.