Are HCA and HHA the Same? Home Care Aide vs Home Health Aide in Washington
In most states, "home care aide" and "home health aide" describe the same work done under different employers, and the titles get swapped freely on job boards and training sites. Washington is the exception. The home care aide is a state credential, issued by the Department of Health after 75 hours of training and an exam.
The home health aide is not a credential at all here; it's a role inside a licensed home health or hospice agency, and the rules governing those agencies say who may fill it. That distinction determines which agencies can hire whom, who supervises the care, and what it takes to move between the two.
What Is a Home Care Aide (HCA)?
The home care aide is Washington's own caregiver credential, created by chapter 18.88B RCW and issued by the Department of Health. Anyone hired as a long-term care worker in the state since 2012 has to obtain HCA certification unless they already hold a nursing credential or fall under an exemption. That covers care staff in home care agencies, adult family homes and assisted living, and individual providers looking after a Medicaid client at home.
Getting there means 75 hours of DSHS-approved training within 120 days of hire, a written and skills exam, and certification within 365 days. The work is personal care: bathing, eating, medication assistance, mobility, and the household tasks around them. It's one of five caregiver credentials Washington issues, and the one most caregivers in the state end up holding.
What Is a Home Health Aide (HHA)?
Outside Washington, "home health aide" is a federal term. Medicare sets the standard in 42 CFR 484.80: at least 75 hours of training, a competency evaluation signed off by a registered nurse, and 12 hours of in-service training every year.
An HHA works for a Medicare-certified home health agency, on a plan of care ordered by a physician, and a nurse or therapist reviews the aide's work on a fixed schedule. The care is clinical in purpose even when the tasks look like personal care.
Washington adds its own rule on top. Under WAC 246-335-510, a home health aide working for a Washington home health agency has to be a nursing assistant certified or a nursing assistant registered under chapter 18.88A RCW. In a hospice agency it's NAC only. So in this state, there is no such thing as an HHA credential. An HHA is a nursing assistant doing home health work, and the credential on their wall says NAC or NAR.
HCA vs HHA: What’s the Difference?
Employer. Both work for in-home services agencies licensed under chapter 70.127 RCW, but under different service categories. A home care agency employs home care aides. A home health agency or hospice employs home health aides. The license is what separates them: a home care agency that takes on nurse-delegated tasks is still not a home health agency, and cannot call its staff home health aides.
What the care is. Home care services are defined in Washington as nonmedical: personal care, homemaking, respite, and delegated nursing tasks that make it possible for someone to stay at home. Home health aide services sit inside a medical plan of care, ordered by a physician or other practitioner, and the aide is part of the clinical team that reports back into it. The hands-on tasks can look identical. What they are for is not.
Supervision. A home care aide works under the agency and the client's plan, with a registered nurse involved only if tasks have been delegated. A home health aide works under a registered nurse or therapist who reviews the care on a fixed cycle: every 14 days under Medicare when the patient is also getting skilled nursing or therapy, and every six months under the Washington rule for aide-only cases.
Who pays. Home health is built around Medicare. Home care is paid by Medicaid long-term care programs, private pay, and long-term care insurance, which is why an HCA can also work in adult family homes, assisted living and the other long-term care settings in Washington while an HHA cannot.
One more term causes confusion from out of state. A "personal care aide" is what most states call the nonmedical role. In Washington that job is the HCA, and the cost of getting HCA-certified is under $1,000 all in. |
From HCA to Home Health Work
An HCA who wants home health or hospice work needs the nursing assistant credential, and Washington built a shortcut for exactly this under WAC 246-841A-545.
Hold a current HCA certification. It's the only entry condition for the alternative program; a lapsed credential doesn't qualify.
Complete the 36-hour alternative program instead of the full 108-hour NAC course: 17 hours of classroom theory, 13 of skills lab, six of clinical training. Cornerstone's HCA to CNA bridge program is built on this rule.
Complete a CPR course. The Board of Nursing requires proof of it with the application.
Apply to the Board of Nursing with the program certificate, proof of the HCA credential, the CPR certificate and the $85 fee.
Pass the competency evaluation. It's the same one every nursing assistant takes; the bridge shortens the training, not the exam.
Register as a NAR in the meantime if you need to start work first. A home health agency can employ a NAR as a home health aide. A hospice agency cannot, since its definition is NAC only.
The crossing works in the other direction too, and it's shorter. A Medicare-certified home health aide hired into long-term care within a year of that job, or anyone already holding a NAC, is waived from the 70 hours of basic HCA training under WAC 246-980-025 and RCW 18.88B.041.
What they cannot skip is the HCA certification exam. So an HHA moving into an adult family home or a home care agency takes one exam; an HCA moving into home health takes 36 hours and one exam.
Which One to Choose
The setting decides it. Home health and hospice agencies need nursing assistants, so anyone aiming at that work needs the NAC, and the full route to becoming a CNA in Washington takes 108 hours plus the competency evaluation.
Everything else in long-term care (home care agencies, adult family homes, assisted living, individual provider work) needs the HCA. Most caregivers in the state start there, because it opens more doors than any other single credential and because the 36-hour bridge makes the NAC an add-on later rather than a separate career decision.
For employers the rule runs the other way. A home health agency hiring an aide checks for a NAC or NAR, not an HHA certificate, because Washington doesn't issue one. A home care agency or facility hiring someone with home health experience checks for HCA certification and, if it isn't there yet, starts the clock: the 70 hours are waived, the exam is not.
The confusion comes from the rest of the country, where the two titles are interchangeable and the difference is which agency wrote the job post. Washington drew a line: one is a credential, the other is a role, and the role belongs to nursing assistants.
That is why an HCA cannot simply take a home health job, and why a home health aide cannot walk into an adult family home without taking an exam. Crossing in either direction is short, 36 hours one way and one exam the other, and it starts with HCA certification, the credential the rest of Washington's caregiving is built on.
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