Clinical Training Recommendations for Home Health Aides and Certified Nursing Assistants

These training recommendations will help home health aides and certified nursing assistants (CNAs) address the unique needs of patients living with serious illness.

Assess the Needs and Concerns of Patients

• Observe for signs of pain and other distress through body language (patient is resisting care or curled in a ball), behavior (striking or yelling out during care), or facial expressions of fear or anxiety
• Use communication skills to ask simple-to-gather information through open-ended, non-judgmental questions such as “Does this hurt?” and “Are you in pain?”
• Record the behaviors you observe in the care plan or medical record
• Report changes in a patient’s condition, behavior, interactions, and relationships to supervisor

Strengthen the Clinician-Patient Relationship and Understand Goals of Care

• Develop a warm and trusting relationship with the patient
• Get to know the patient’s life story by looking through photos or talking about the past
• Use communication to ask what the patient wants and doesn’t want
• Document the patient’s wishes, concerns, and preferences in the care plan or medical record
• Support patient choice and control whenever possible (for example, let them eat or bathe at different times or allow wandering rather than sitting down at meal times)

Manage Pain and Symptoms

• Remind and support the patient to take their medications, using preferred foods to help, or distractions such as music
• Encourage and support the patient’s mobility, such as assisting with transferring, walking, and other activities
• Encourage and support the patient’s social interaction with you and others through video, phone, and/or in-person events and connections

Prevent Crises and Plan Ahead

• Maintain a safe and secure living space
• Remove trip hazards and fire hazards
• Report the need for grab bars, elevated toilet seats, or lift chairs to your supervisor
• Make a list for the patient with contact information for the program, family members, doctor’s office, and local emergency services
• Explain how patient information is shared, and with whom