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Home Health Care & Licensing Standards

May 8, 2022
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WRITTEN BY Dr. Ramon Martinez III

Executive Summary 

Home health is a type of medical care that delivers care in patients’ homes rather than in a centralized location (such as a nursing or convalescent home). This type of care is making up a growing portion of the marketplace for medical needs of older adults. Many of these services are approved and funded by the federal Medicare or Medicaid programs, and require relatively minimal training requirements. While some states have restrictive policies regarding the scope of practice of health aides or duties aides can perform under a supervising nurse, some pilot studies have looked into the viability of delegating more duties to home health aides. Introduced in the Missouri 2022 legislative session, HB 2371 expands the list of medical professionals that are eligible to plan and provide support for home health services to include podiatrists, nurse practitioners, clinical nurse specialists, and physician assistants. 


  • One study has found that when nurses were authorized to delegate home health treatment plans (such as medications and other tasks) to home health aides, there were no adverse outcomes to health and higher levels of patient satisfaction.
  • Home health was estimated to cost $18 billion in annual Medicare spending in 2017, covering roughly 3.4 million home-bound Americans. 
  • There is a growing need for workers in the home health care field; Missouri has seen a steady increase of workers from 2009-2020. 
  • Rural, Black and Latino minorities, and low-income older adults are less likely to utilize and have access to high-quality home health services. 
  • Barriers to increased workforce recruitment and retention of home health aides include: 
    • Low wage or hours, uncertainties in immigration policies, low-quality supervision, lack of career mobility, occupational safety hazards, stigma of work, lack of training, and perceived lack of value.


  • Overall, there is little research on the impact of home health and home care aide scope of practice or delegation of duties to aides on access to care.
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