Does Mom Need a Nurse or a Health Aide?

I often hear people use the term ‘nurse’ to describe the person who comes to the house to help mom or dad bathe and get dressed three or four times a week. There’s apparently a lot of confusion out there between what home health aides and nurses do.

The person who helps your loved one bathe and dress is typically a Home Health Aide (HHA) or Certified Nursing Assistant (CNA). There are other titles and designations for this type of help, but HHA and CNA are two of the most common.

While many HHAs have a high school diploma or a GED, formal education generally is not required to be an HHA. Home care agencies typically provide their own training programs. Some states do offer a training and certification process to become a certified home health aide, or CHHA.

CNAs must pass a state licensing exam to be certified. This requires a formal training program offered by community colleges and vocational and technical schools. Candidates must learn basic principles of nursing care and complete several hours of supervised clinical training.

HHAs and CNAs working in the home setting may assist with bathing, dressing and other self-care and hygiene needs. As needed, they may also grocery shop, prepare meals, help clients eat, perform light housekeeping and provide occasional transportation.

In healthcare language, both CNAs and HHAs are considered “Unskilled” help. By definition, “Skilled” services are functions that must be performed by a licensed practical nurse (LPN) or a registered nurse (RN).

All states require RNs to earn at least an associate degree, but some employers prefer candidates with bachelor’s degrees. RNs must also be licensed to practice, a process that requires that they complete an accredited nursing program, lasting from two to four years, and pass the National Council Licensure Exam for Registered Nurses, or NCLEX-RN.

LPNs must complete a state-approved training program, often in the form of a diploma, certificate or associate degree. The majority of programs can be completed in one year, although some offering an extensive nursing curriculum may take longer. Individuals must then pass the National Council Licensure Examination for Practical Nurses, or NCLEX-PN.

While the differences between RNs and LPNs are beyond the scope of this article, both are qualified to provide more advanced care than HHAs and CNAs. In general, nurses may administer medication, perform wound care, create and implement detailed care plans, and collaborate with doctors and other members of your loved one’s healthcare team.

Hiring an HHA or CNA is usually one of the first steps in planning to keep your loved one safe at home. They are typically employed at a home care agency in your area and are private pay (meaning not covered by insurance).

Nursing care may or may not become necessary as certain health conditions progress and are often ordered by your family doctor. When ordered by a doctor for a specific illness or condition, nursing services are generally covered by health insurance. There are also private duty nurses that can be hired by an individual patient, their family, or an agency. They are not necessarily under the direction of a physician and their salary is paid by the individual.

It’s important to make an accurate assessment of your loved one’s needs and obtain the proper level of  help to keep them safe and healthy at home. Many times family members are overwhelmed by the prospect of figuring things out, or have differing opinions about what’s best for mom and dad. This often results in family strife, leading to inertia and nothing gets done until there’s an emergency. If this is the case in your family, it may be wise to hire a professional health advocate to perform a comprehensive and objective assessment for the family.

Contact Cathy Abreu, RN, BCPA at or 484-548-0201

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Tools for Interacting With People Who Have Dementia

Dementia is a general term for a loss of memory and other thinking abilities that is serious enough to interfere with activities of daily life. It has many causes, the most common cause is Alzheimer’s disease.

A diagnosis of dementia can have a huge impact on a person’s life. Someone recently diagnosed with dementia is likely to experience a range of emotions. These may include grief, loss, anger, shock, fear, disbelief and even relief from finally understanding their diagnosis.

Living with dementia presents many challenges for patients and their families. As a family member, friend or caregiver, there are specific ways we can interact with people with dementia that can increase the quality of our interactions and decrease many common frustrations.

Interacting with People Living with Dementia

• Slow your pace and allow time for the person to process and respond
• Simplify sentences or choices
• Ask one question at a time
• Speak clearly and calmly, be patient, listen
• Avoid arguing or embarrassing the person
• Seek to understand the person’s reality or feelings
• Gently redirect to another environment or subject as needed

We can all work together to spread dementia friendly practices by partnering with advocacy groups, state agencies and regulators to learn more about, follow and encourage dementia friendly practices in our communities.

People living with dementia still need the same things we all do – love, support, connection, community and engagement. It’s important to always remember that although someone with dementia may behave differently, they still deserve to live with dignity, respect and at their highest possible quality of life.

Contact Cathy Abreu, RN, BCPA at or 484-548-0201 for more information on living with and caring for people with dementia. Visit us online at!

We’ve Lost our Way – Here’s Hope: Meditation

For years we have seen statistics saying, despite our wealth and material abundance, Americans are far from the healthiest people on the planet. If you need evidence, look at the devastating influence of COVID-19 on our nation.

Check out the news today and it’s obvious something is wrong. While this is a big health topic, I will address just one foundational concern. If we address just this issue, we will see a transformation in the quality of our lives.

Rest and Balance, the Missing Ingredients

The critical need I am referring to is BALANCE, and the place to start is: get more rest! Without adequate rest, we place our lives in danger.

In his classic, SABBATH: Finding Rest, Renewal, and Delight in our Busy Lives, author Wayne Muller analyzes this problem superbly. In our culture, we prize activity and accomplishment above all else. “Don’t just sit there, do something. Go, go, hurry, hurry. Doing something, anything is better than doing nothing.” We’ve all heard it.

Yet, all life is dependent upon a rhythm of rest for its survival. The importance of this most essential rhythm – rest and activity – is lost on us today. Take a look around. How many times have you seen a group of friends, sitting at a table in a restaurant, glued to their phone’s display.

In our world, “I am so busy” is a common refrain. Meanwhile, our blood pressure and anxiety level is rising, and sleepless nights are commonplace.  These are all classic signs of the stress response. The bad news is that stress accumulates over time, and this is a driver of our poor health mentioned above.

Life hasn’t always been this way. When I was a child, life was very different. Personal computers and smartphones didn’t exist. Life was slower and simpler. Sure, there was stress as there will always be, however there was more balance in our lives. Sunday’s were a day of rest, a time to gather with family. Shopping was minimal due to the laws that required most stores to be closed on Sunday.

The Way Back Home

So what can we do to create balance and more satisfaction in our lives? The pace of life is most likely not going to slow down. Fortunately, the solutions are right before our eyes. All we need to do is look to nature for clues as how to live in balance.

For starters, there are cycles or rhythms in nature. All life requires a rhythm of rest. The bustling activity of each day turns into the stillness and rest of the night. The growth in spring and summer turns into the nourishing decay of leaves in the fall and the rest/dormancy of winter. Each beat of our heart and inhalation of breath is followed by a brief pause, a period of rest.

To restore balance, a good place to start is to set up a daily routine that includes adequate sleep. Most experts tell us getting to bed at a consistent hour and waking at a routine hour in the morning are very helpful. Our bodies adjust well to routines especially ones in alignment with nature.

A practice that ties all this together is meditation. Effortless Meditation, in particular, is a simple mental technique that when practiced regularly for 5, 10, 15 or 20 minutes, restores nature’s rhythm of rest to our lives.

The restorative power of deep rest is truly transformative. New meditation clients have said they feel like they are coming home during the practice. Rest heals and revitalizes our mind, body, and spirit. That’s why many meditate early in the morning before work and then after work. After a short meditation, we are good to go!

Everyone is happier, healthier, and at their best when their energy level is high. Meditation anyone?

Greg Schweitzer, Director, Stress Reduction Resources