CNA vs Home Health Aide: Training, Pay and Where You Work
Both jobs start with the same 75-hour federal training minimum. The difference is where you work and what you're paid, and a CNA certificate can count for both.
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The short answer
- Same federal training floor. Both need at least 75 hours of training, including at least 16 hours of supervised practical training.
- One credential can cover both. A CNA who is listed in good standing on the state nurse aide registry also meets the federal requirements to work as a home health aide for a Medicare-certified home health agency.
- Different workplaces. Most nursing assistants work in nursing homes and hospitals. Most home health and personal care aides work in people's homes.
- CNAs earn more in Texas. In May 2025, the Texas median was $18.03 an hour for nursing assistants and $11.65 for home health and personal care aides, a gap of $6.38 an hour.
Side by side
| CNA (nurse aide) | Home health aide | |
|---|---|---|
| Federal training minimum | 75 hours, at least 16 supervised practical | 75 hours, at least 16 supervised practical |
| Texas training | 100 hours: 60 classroom, 40 clinical | Federal rules for Medicare-certified agencies; agencies may ask for more |
| How you qualify | Usually a state-approved program, then the state exam; listed on the nurse aide registry | Training and a competency evaluation by a registered nurse, or CNA registry listing in good standing |
| Ongoing training | 24 hours every two years (Texas and Florida) | 12 hours every 12 months |
| Main workplaces | Nursing homes (36%), hospitals (32%) | Clients' homes, through individual and family services (51%) and home health agencies (23%) |
| Median pay, Texas | $18.03/hr | $11.65/hr |
| Median pay, Florida | $18.03/hr | $16.25/hr |
| Job growth, U.S. 2025–35 | 3% | 18% |
Sources: 42 CFR §483.152, 42 CFR §484.80, Texas HHSC: Become a Certified Nurse Aide in Texas, BLS Occupational Outlook Handbook and OEWS (May 2025). Home health figures from BLS combine home health aides and personal care aides. Checked November 2, 2026.
Training: the same federal minimum
Federal rules set the floor for both jobs. A state-approved nurse aide training program must include at least 75 clock hours, with at least 16 hours of supervised practical training and at least 16 hours of training before any direct contact with a resident.
Home health aide training for Medicare-certified agencies has the same total: at least 75 hours of classroom and supervised practical training, with at least 16 hours of classroom training before at least 16 hours of supervised practical training.
States can require more. Texas, for example, asks CNA students for 100 hours: 60 in the classroom and 40 in clinical training. How long CNA training takes in Texas and Florida.
Sources: 42 CFR §483.152(a); 42 CFR §484.80(b); HHSC. Checked November 2, 2026.
A CNA can also work as a home health aide
Federal rules list four ways to qualify as a home health aide for a Medicare-certified agency. One of them is completing a state-approved nurse aide training and competency evaluation program and being listed in good standing on the state nurse aide registry. In other words, a CNA already meets the federal bar.
The other routes are a home health aide training and competency evaluation program, a competency evaluation on its own, or a state licensure program that meets the same standards. A registered nurse must perform the competency evaluation.
Why it matters: CNA training keeps both doors open, nursing homes and hospitals as well as home health. Home health aide training alone doesn't put you on the nurse aide registry.
Source: 42 CFR §484.80(a)(1) and (c), checked November 2, 2026. Agencies that don't take part in Medicare, and non-medical home care, can set their own requirements, so check each job posting.
Where each one works
According to the Bureau of Labor Statistics, the largest employers of nursing assistants are nursing care facilities (36%), hospitals (32%), continuing care retirement communities and assisted living (11%) and home healthcare services (5%).
Home health and personal care aides work mostly in clients' homes. Their largest employers are individual and family services (51%) and home healthcare services (23%), followed by residential facilities for people with intellectual and developmental disabilities (6%) and retirement communities and assisted living (6%).
Home health aides may check vital signs, depending on state rules, and help with medications and simple prescribed exercises under a nurse's direction. They keep records and report changes in a client's condition to a supervisor or case manager.
Sources: BLS Occupational Outlook Handbook, Nursing Assistants and Orderlies and Home Health and Personal Care Aides, checked November 2, 2026.
Pay in Texas, Florida and the U.S.
Median pay in May 2025: half of workers earned more and half earned less.
| Area | Nursing assistants | Home health and personal care aides |
|---|---|---|
| Texas | $18.03/hr ($37,500 a year) | $11.65/hr ($24,230 a year) |
| Florida | $18.03/hr ($37,510 a year) | $16.25/hr ($33,800 a year) |
| United States | $20.32/hr ($42,260 a year) | $17.21/hr ($35,800 a year) |
Texas employs far more home health and personal care aides (329,590) than nursing assistants (88,680), but at a much lower median wage. CNA pay by metro area in Texas and Florida.
Source: BLS OEWS, Nursing Assistants (31-1131) and BLS OEWS, Home Health and Personal Care Aides (31-1120), May 2025 data, retrieved November 2, 2026. BLS reports home health aides and personal care aides together.
Keeping your credential current
- CNAs in Texas and Florida need 24 hours of in-service training every two years to renew. CNA renewal in Texas and Florida.
- Home health aides at Medicare-certified agencies need at least 12 hours of in-service training in each 12-month period.
- CNAs who go 24 consecutive months without paid nursing-related work must, under federal rules, complete new training or a new competency evaluation before working as a nurse aide in a nursing facility again.
Sources: HHSC and Florida Board of Nursing renewal rules; 42 CFR §484.80(d); 42 CFR §483.35(d). Checked November 2, 2026.
Which should you choose?
- Choose CNA training if you want the widest choice of jobs. It covers nursing homes and hospitals, and it meets the federal bar for home health aide work too.
- Consider home health aide training if you only want one-on-one work in people's homes and an agency offers to train you. Ask whether it's Medicare-certified, since that decides which federal rules apply.
- Ask about free training either way. A nursing facility can't charge you for approved CNA training if it employs you or has offered you a job. How free CNA training works.
Common questions
Can a CNA work as a home health aide?
Yes, for a Medicare-certified home health agency. Federal rules accept completion of a state-approved nurse aide training and competency evaluation program, with a listing in good standing on the state nurse aide registry, as one way to qualify. Other agencies can set their own requirements.
Is home health aide training shorter than CNA training?
Not under federal rules: both have a 75-hour minimum with at least 16 hours of supervised practical training. States can require more for CNAs. Texas requires 100 hours.
Who earns more, a CNA or a home health aide?
In May 2025, the median was $18.03/hr for nursing assistants and $11.65/hr for home health and personal care aides in Texas, and $18.03/hr and $16.25/hr in Florida, according to the Bureau of Labor Statistics. CNA pay by metro area.
Which job has more openings?
BLS projects about 760,500 openings a year for home health and personal care aides combined, and about 203,300 for nursing assistants and orderlies combined, on average from 2025 to 2035. Home health and personal care aide jobs are projected to grow 18%, compared with 3% for nursing assistants.
Do I need both certifications?
Not for Medicare-certified home health agencies: a CNA in good standing on the registry already qualifies. A home health aide certificate on its own doesn't put you on the nurse aide registry, so it doesn't qualify you for nursing home CNA jobs.
Find approved CNA classes near you
Search 1,030 state-approved programs by city or ZIP code, or use your location.
Sources
- 42 CFR §483.152 Requirements for nurse aide training (Cornell LII)
- 42 CFR §484.80 Home health aide services (Cornell LII)
- 42 CFR §483.35 Nursing services (Cornell LII)
- Texas HHSC: Become a Certified Nurse Aide in Texas
- BLS Occupational Outlook Handbook: Nursing Assistants and Orderlies
- BLS Occupational Outlook Handbook: Home Health and Personal Care Aides
- U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (OEWS), Nursing Assistants (31-1131)
- BLS OEWS, Home Health and Personal Care Aides (31-1120)
This guide explains official rules in plain language. It isn't legal advice. Your state's regulator has the final word.