≥ 92% of participants will know how to provide personal care to patients within the scope of practice for a Certified Nurse’s Aide or Home Health Aide.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
≥ 92% of participants will know how to provide personal care to patients within the scope of practice for a Certified Nurse’s Aide or Home Health Aide.
At the completion of this course, learners will have met the following:
Providing personal care to patients is an imperative part of working as a certified nurse’s aide (CNA) or home health aide (HHA). Patients requiring assistance in their home or at an assisted living facility are often not equipped mentally and/or physically to provide proper personal care for themselves. Personal care includes hygiene practices, incontinence management, activities of daily living such as assistance with dressing and feeding, ambulation and transfers, and even light housekeeping. It is up to the CNA or HHA to know best practices and understand the fundamental principles of personal care. Performing these services for patients requires compassion and sensitivity. One of the most important goals is to maintain the patient’s dignity.
Patients must also be treated with common courtesy. For example, a home health aid should knock and wait before entering a patient's room, respond politely to patients, listen to patients, and remain compassionate. According to Malenfant et al. (2022), all patients have the right to fair and equal health care services regardless of the following:
CNAs and HHAs can perform personal care services, including hands-on assistance and providing directions to patients during care tasks. CNAs and HHAs are supervised by a registered nurse (RN) and follow a care plan developed by an RN and provider. Personal care services vary based on patient needs, care planning, and state regulations. According to the U.S. Bureau of Labor Statistics (2025), these services may include:
One goal of personal care services is to meet patients' needs while maintaining dignity and independence. One way to achieve this is to have the patients do as much as possible for themselves (Sæteren & Nåden, 2021). The patient may be slow in dressing, but the patient must keep dressing themself to maintain as much function as possible. When patients do not get up to walk, sit up, or use their hands, they can lose function quickly. Patients also benefit from exercise. If specific exercises are on the care plan, a CNA or HHA can coach a patient through a range of motion and strength exercises (Bičíková et al., 2021).
Patients deserve to make choices when they can. Let them choose what to eat, wear, and do other activities if possible. Patients also need mental stimulation unless the care plan says otherwise. Some patients with dementia react badly to stimulation and changes in routine. This may include the introduction to new people, new places, and different eating times (U.S. Department of Health and Human Services, 2025).
Treat any laundry that has bodily fluids on it as if it is contaminated. Use disposable gloves to handle anything that has bodily waste. This can include clothing, tissues, paper towels, wipes, or diapers. Make sure to put the contaminated waste in a leak-proof, heavy-duty bag and tie it shut. Put the material in a second plastic bag. Follow local regulations for solid waste disposal. Most areas use standard trash pickup. Ensure feces are flushed down the toilet.
Rules about assistance with medication disposal vary by state and agency (Centers for Disease Control and Prevention, 2024c). It is important to meet your agency's requirements. Additionally, agency rules can guide you on how to remind patients to take their medications and follow their care plan
Registered nurses, physical therapists, or occupational therapists will obtain assistive equipment as needed, but CNAs and HHAs may recognize when equipment is needed first since they are generally with the patients the most. If it is recognized that equipment is needed, the CNA or HHA can request it. Healthcare professionals must be formally trained to use medical devices or transfer equipment. Never attempt to use equipment without proper training first. Equipment that can be used to improve safety for workers and patients includes:
Falls are the leading cause of injury-related deaths in the elderly (Centers for Disease Control and Prevention, 2024a). Any elderly patient you work with should have a fall risk assessment and plan of care to prevent falls. According to the CDC (2024a), things that contribute to falls include:
If a patient falls, ensure they are still conscious. If they are conscious, ask the patient if they are okay and if they can get up on their own. If the patient is injured, in pain, or cannot move part or all of their body, call 911 immediately (Centers for Disease Control and Prevention, 2024a).
If the patient thinks they can get up, bring a chair close to the patient. Ask them to roll onto their side and get on their knees. Next, ask the patient to support themself with the chair while they stand up. Do not attempt to lift the patient by yourself (Centers for Disease Control and Prevention, 2024a).
There are a variety of ways you may be involved in helping a patient transfer. You may assist a patient from sitting to standing, standing to sitting, lying down to sitting, or sitting on a chair to sitting on a bed. Good communication must be used at all times. Transfers are successful when closed-loop communication is used and when everyone takes their time. Always make sure the supplies you need are readily available before the transfer begins. If you need a walker or gait belt, locate it and have it positioned correctly (Bergman & De Jesus, 2022; Fray & Davis, 2023).
During all transfers, the caregiver must ensure he or she is using proper body mechanics. Proper body mechanics is key in preventing injury to yourself, primarily to the back and neck. Ensure you are lifting with your legs, not your back! Make sure to keep your back and neck straight, and your feet shoulder-width apart. Stand as close to the patient as possible. Avoid stretching, bending, or reaching over, as this can result in injury to your back (Bergman & De Jesus, 2022).
There are a few different ways you can assist a patient to transfer from sitting to standing. If a patient has a walker, you can provide it to them. Situate the walker in front of the patient. Advise the patient to position their hands on the chair arms or bed. Next, have the patient push off the chair or bed using their hands and the strength of their legs (Reuter-Sandquist, 2022).
If a patient requires more assistance, the CNA or HHA can position themselves slightly off to the side of the patient and grab hold of the patient’s waistband or gait belt (if available) to help hoist the patient to stand. Once the patient is standing, they can place their hands onto the walker.
You should be communicating each step with the patient so they can anticipate what will happen next. Continually asking them how they feel and if they are ready to stand will help ensure you both are on the same page. Saying something like, “On the count of three, you will stand up,” can help confirm you both know what to expect next. Once the patient is ready to stand, you will help lift the patient with the strength of your legs and the momentum created by rocking (Reuter-Sandquist, 2022).
Assisting a patient from standing to sitting is a bit easier to navigate, but still requires patience and good communication.
In some cases, a patient is strong enough to transition from lying to sitting with minimal assistance, but in other cases, the patient will be too frail or sick and require more help. In these instances, when a patient is lying in bed and needs to sit up, there are generally three different ways to approach this (Reuter-Sandquist, 2022).
The first way requires a mechanical hospital-grade bed. When a patient has access to this type of bed, the caregiver should elevate the head of the bed as high as possible, then gently swing the patient’s legs over the side of the bed. The second approach is suitable when the patient’s bed cannot be adjusted. In this case, the patient should lie on their side, and the caregiver will gently position their legs towards the side edge of the bed. Next, the caregiver will embrace the patient around their trunk and lift them up to sit. This approach should only be done when both the caregiver and patient are strong enough. The third method requires a Hoyer lift. A caregiver who is trained in using a Hoyer would position the lift accordingly and mechanically lift the patient to sit. This method would also be used if the patient needed to be transferred from chair to bed or vice versa and could not bear weight on his legs (Bergman & De Jesus, 2022; Reuter-Sandquist, 2022).
According to Fray & Davis (2023), devices that assist in caring for and moving patients include:
Bathing can be an enjoyable experience and improve the quality of life. Encourage the patient to bathe themself as much as possible to maintain function. It is essential to have all the bathing supplies ready before starting and to keep the room warm. Respect the patient's privacy, but be sure to inspect the patient's skin for any wounds, unusual bruising, and rashes. Notify your supervisor of changes or red areas (National Institute on Aging, 2024).
A complete daily bath may not be necessary for an elderly patient, especially if they struggle with very dry skin and are generally inactive. However, the hands, face, and genital areas should be cleaned daily. It is important to remember that patients have a choice to bathe or not. As healthcare professionals, we can only encourage it. Patients with dementia may be particularly challenging to bathe. If the patient is refusing baths, notify your supervisor (National Institute on Aging, 2024).
Tub baths, showers, and sponge bathing are part of the care plan. Ask the RN if the method of bathing is unclear. Remember, the goal is to keep the person up and moving as much as possible.
Use caution with hot water. Always test it out on yourself before encouraging your patient to step in. Do not use bath oil products because they make the tub slippery and increase the risk of falls (National Institute on Aging, 2024).
Safety equipment for bathing includes:
Soaking a patient's feet for a limited time and toenail filing are allowed.
Shampoos may be provided unless restricted by the care plan. Combing, setting hair with curlers/pins, and blow-drying a patient’s hair are allowed. The blow dryer must be used on the low setting following the manufacturer's recommendations. The use of curling irons, electric curlers, or haircutting is not allowed. Using chemical hair products is also not allowed (National Institute on Aging, 2024).
Washing hair in the kitchen sink is an option if the tub or shower is too difficult. Devices can be used to catch water when washing hair in bed. A dry shampoo product can be used when washing is difficult (National Institute on Aging, 2024).
Elderly patients often struggle with dry skin. Applying lotion on a regular basis can be soothing to the skin as well as calming to the patient.
It is acceptable for a CNA or HHA to assist a patient in shaving. An electric shaver is preferable. Before shaving, the patient should be in a sitting position with any dentures or partials in their mouth. Straight razors are never allowed.
Be prepared to assist or coach the patient when they are dressing, allowing them to perform the task themselves as much as possible. Always encourage the patient to choose their own outfits and be flexible and considerate of the patient's desires. Wearing a bra or pantyhose may or may not be important to the patient. Easy-to-use clothing should be used; this includes large fasteners in the front. Zippers or Velcro are generally easier to manage than buttons. Elastic waistbands and slip-on shoes are easier than button pants or shoes that tie. Shoes and slippers need to be well-fitted. If the patient has a weak or painful side, put the weak side into the sleeve first. When removing the clothes, take off the strong arm first. Anti-embolism stockings are only allowed if it is on the care plan (National Institute on Aging, 2024).
Personal items aids can assist with those that may not be listed on the care plan, including:
Personal items for assistance can ONLY be used if they are on the care plan and if the patient is mentally alert. These items include:
Assistance with contact lenses or NEW braces, splints, prostheses, or slings is not allowed.
Devices that can help with toileting are:
You may be assisting with a bowel/bladder training regimen. That usually includes toileting every 2 hours. If that is too often, start with every 3-4 hours. Rushing when there is an urge may result in incontinence (Davis et al, 2020).
The following actions are not allowed:
When communicating with a patient who has a hearing impairment, face the patient and speak clearly. Use short sentences. Repeat yourself as needed. Do not shout. Touch the patient to get their attention. Keep background noise to a minimum. Finger spelling and writing things down can be helpful (American Speech-Language-Hearing Association, n.d.; Centers for Disease Control and Prevention, 2024b).
When communicating with a patient who has a visual impairment, make sure the lighting is good. Do not move furniture around. Keep clutter off the floors. Use black and white clocks and telephones. Large numbers and letters are easier to read. Keep glasses close and clean. Mark knobs and devices with dots or tape to identify where to turn or push the knobs. Use the back burners and turn the handles toward the stove to stop accidental spills (Wisconsin Department of Health Services, 2023).
When communicating with a patient who has a speech impairment, keep a pencil, pen, and paper close. Do not talk for the patient. Do not talk in front of the patient to another person as if they cannot hear what you are saying (American Speech-Language-Hearing Association, n.d.).
When caring for a patient who has lost a limb or has limited use of a limb, assist as needed. Ask the patient what they want done for them or review the care plan. Do not over-assist the patient. The patient needs to maintain as much function as possible. They also need to maintain their self-respect. Elevating an impaired limb will help reduce swelling (Illinois Department of Human Services, n.d.).
Bedsores are also called pressure sores, decubitus ulcers, or pressure ulcers. Bedsores are painful and can be difficult to heal. A sore happens when blood vessels are squeezed or pressed between a surface and bony areas. Typically, a healthy person would feel the pressure and move. However, some patients are not able to move or do not feel the pressure. Rubbing and friction also cause sores. When parts of the patient's skin are pulled across a surface, rubbing and friction can cause sores. Continued exposure to wetness causes bed sores. It is important to remove urine and feces (Zaidi & Sharma, 2024).
There are four stages to bed sores, each worse than the previous. The stages are (Zaidi & Sharma, 2024):
If the patient needs help eating, treat them like an adult, give them choices, and remain patient. Always encourage independence. Make sure dentures and glasses are in use while eating if needed. Providing finger foods can be a good alternative if using a fork and spoon is difficult. Consider using a nonslip pad under the plate to keep the plate from sliding around. Using divided plates or plates with rims can help the patient scoop food themself. Larger spoons and forks are generally easier to use (O'Hara-Leslie et al., n.d.).
When assisting a patient with feeding, ensure they are sitting upright with minimal distractions. If the patient has suffered from a stroke, ensure you are sitting on their strong side. If the patient is cognitively impaired, remind them that you are assisting with feeding and remind them to chew and swallow (O'Hara-Leslie et al., n.d.).
If the appetite is poor or the patient refuses to eat, limit distractions and use smaller portions. Providing only one or two food items on a plate can help make mealtimes feel less overwhelming. It is also important to keep in mind; a patient’s appetite may improve when mealtimes are enjoyable. Additionally, don’t be afraid to ask the patient why he does not want to eat, especially if this is a new issue. Common issues that can deter a person from eating include tooth pain, mouth pain, or denture problems. These issues should be addressed and corrected by the care team (O'Hara-Leslie et al., n.d.).
If the patient chokes easily or has trouble swallowing, check the care plan to see if you can feed the patient (O'Hara-Leslie et al., n.d.). If you are approved to provide tube feeding, follow your employer's policy and procedure.
Renee, a newly certified nurse’s aide (CNA), begins her first assignment at a home health agency. Her patient is Nancy, an 86-year-old woman who is homebound and living with dementia. Nancy requires assistance with bathing, dressing, transfers, ambulation, and meal preparation. Nancy also has a gait belt, but during Renee's shift, it could not be located. Renee is enthusiastic but also understands the importance of respecting patient dignity, autonomy, and comfort, especially when working with vulnerable individuals such as those with cognitive impairments.
During Renee’s first shift, she attempts to assist Nancy with her bath, but Nancy becomes agitated. Instead of insisting on a full bath, Renee calmly suggests a brief sponge bath, focusing on essential areas. Renee also communicates gently and respectfully, using a soft tone and clear instructions. She ensures privacy, gathers supplies in advance, and maintains a warm environment. Because the gait belt is missing, Renee carefully used the waistband of Nancy’s pants to assist with standing or transferring. Renee documents the missing gait belt issue and notifies her supervisor with a request for a new gait belt. She continues to assist Nancy with grooming and dressing using patient-led techniques, encouraging Nancy to choose her own clothing and do as much as she can independently.
By respecting Nancy’s autonomy and emotional state, Renee successfully builds trust. Nancy accepts the sponge bath and remains calm throughout the personal care process. No falls or safety incidents occur because Renee avoids unsafe transfers without a gait belt. The respectful, patient-centered approach fosters a safer environment and improves Nancy's willingness to participate in future care tasks. Renee’s ability to adapt while following care protocols results in a positive outcome for both the patient and herself.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.