Home Health Aide Requirements: Competency, In-Service and Records
Short answer: a home health aide may furnish services for a Medicare-certified agency only after passing a competency evaluation performed by a registered nurse, and must receive at least 12 hours of in-service training in each 12-month period, with documentation kept by the agency (42 CFR 484.80(c)-(d)).
Updated October 14, 2026 · Checked against the official sources listed at the end
Competency evaluation before the aide gives care
Under 42 CFR 484.80(c), an individual may furnish home health services on behalf of an agency only after successfully completing a competency evaluation program. The evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate.
Some skills must be evaluated by watching the aide perform the task with a patient or pseudo-patient; the rest can be written, oral or observed. An aide is not considered competent in any task rated unsatisfactory and must not perform it without direct RN supervision until retrained and re-evaluated. An unsatisfactory rating in more than one required area means the aide did not pass.
12 hours of in-service training every 12 months
A home health aide must receive at least 12 hours of in-service training during each 12-month period (484.80(d)). It can happen while the aide is caring for a patient, can be offered by any organization, and must be supervised by a registered nurse. The agency must keep documentation showing the requirement was met.
What to keep for each aide
- The competency evaluation: date, the RN who performed it, each subject area and its rating.
- Any task rated unsatisfactory, the retraining and the re-evaluation.
- In-service hours for each 12-month period, with dates, topics and the supervising RN.
- Your state's own items: background check, registry check, TB screening, CPR, license or certification.
How Pact handles it
Pact keeps each aide's competency evaluation, in-service hours, background and registry checks, TB and CPR on one page, with reminders 30, 14 and 7 days before anything runs out. Aides upload certificates from their phone with no app or password, and every staff member is checked against OIG's exclusion list monthly. $10 per active staff member a month, $250 minimum, first month free.
Common questions
Who can perform a home health aide competency evaluation?
A registered nurse, in consultation with other skilled professionals as appropriate (42 CFR 484.80(c)(3)).
How many in-service hours does a home health aide need?
At least 12 hours in each 12-month period, supervised by a registered nurse (484.80(d)).
Can in-service training happen during patient visits?
Yes. The rule says in-service training may occur while an aide is furnishing care to a patient (484.80(d)).
Does this apply to private-pay home care agencies?
Part 484 applies to Medicare-certified home health agencies. Non-medical and private-pay home care agencies follow their state's licensing rules, which often have their own training-hour requirements.