Practice Information

Advanced Home Health Aides

General Information | Frequently Asked Questions

General Information

A new law allows registered professional nurses (RNs) to assign advanced home health aides (AHHAs) to perform advanced tasks for certain home care and hospice patients. This law requires AHHAs to perform these assigned advanced tasks under RN supervision.

  • An AHHA is a certified home health aide who is qualified, under New York State Law, to perform advanced tasks and is listed in New York State’s Home Care Worker Registry as an advanced home health aide or AHHA.
  • Advanced tasks are some (but by no means all) nursing tasks commonly performed by licensed practical nurses (LPNs) in a patient’s home.
  • The AHHA and RN must be employed by the same New York State licensed hospice, home care services agency, or enhanced assisted living residence - and - they must provide services to their employers’ patients at home.

The RN’s Role - Assignment of Advanced Tasks and Supervision of AHHAs

Before assigning an advanced task for a new patient, the RN must:

  • Assess the patient to ensure that it is clinically appropriate to assign the advanced task to an AHHA.
  • Verify that the patient (or a person who can consent to care for the patient) has consented to the assignment.
  • Train the AHHA to perform the advanced task.
  • Verify that AHHA can perform the advanced task correctly, communicates well with the patient, and agrees to perform the advanced task for the patient.
  • Provide the AHHA with written, patient specific instructions for performing the advanced task and responding to problems.

The supervising RN must provide training, guidance, and direction to the AHHA and may assign, void or modify assignments of advanced tasks, as needed. The supervising RN must be available to speak with and help the AHHA, as needed. If the RN is not at the same location as the AHHA, the RN must be available by phone, at a minimum. A supervising RN must visit the patient at least once every two weeks or more frequently, as needed, to assess the patient, provide care and oversee, observe and evaluate the AHHA, while he or she is providing patient care. If an AHHA is assigned to perform any advanced task for a patient during a shift, the RN must supervise the AHHA whenever the AHHA provides any service for the patient during the entire shift.

The AHHA’s Role - Performing Assigned Advanced Tasks

The AHHA must agree to an assignment to perform an advanced task for a patient. The AHHA should not agree to the assignment, unless the AHHA believes that he or she can perform the advanced task safely and competently. Before performing an assigned advanced task, the AHHA should review the instructions from the assigning RN for performing the task. The AHHA must perform the assigned advanced task in accordance with the written instructions and while under RN supervision. The AHHA must document care provided in the patient’s record.

While working, an AHHA must be able contact his or her supervising RN, as needed. If the supervising RN is not at the same location as the AHHA, the supervising RN must be available by phone, at a minimum.

The AHHA should not perform an advanced task if the patient (or a person who can consent for the patient) refuses the care from the AHHA or if the AHHA is unable to perform it safely. In a non-urgent situation, if something goes wrong while providing care, the AHHA should follow written instructions from the delegating RN for handling the problem or contact the supervising RN for further instructions. In an emergency (such as when a patient unexpectedly and suddenly loses consciousness), the AHHA should call 911 immediately.

Becoming an Advanced Home Health Aide (AHHA)

To become AHHA, you must complete the following 3 steps (IN ORDER):

  • Step 1: You must: (1) have a high school diploma or similar credential; (2) be listed in New York’s Home Care Worker Registry as a certified home health aide; (3) have at least a year of home care experience; (4) have English language and basic math skills; (5) be 18 or older; and, (6) be recently trained in or currently certified in CPR or Basic Life Support.

    NOTE: You will also need government issued identification (i.e., driver’s license, passport, Military ID) to enroll in an AHHA Training Program (see Step 2).

  • Step 2: You must graduate from a New York State approved Advanced Home Health Aide Training Program.

  • Step 3: You must pass the New York Medication Aide Certification Examination (MACE®).

After the New York State Department of Health verifies that you completed all requirements to be an AHHA, you will be listed on New York State’s Home Care Worker Registry as an AHHA.

NOTE: Home care agencies and hospices are legally required to request criminal history background/ record checks for all newly hired AHHAs who will provide patient care. For more information, visit the New York State Department of Health website.

Advanced Home Health Aide (AHHA) Training Programs

AHHA Training Programs teach home health aides how to perform advanced tasks under RN supervision in home settings. All AHHA Training Programs must be approved by New York State and meet the following minimum standards:

Faculty: All faculty must be New York State licensed registered professional nurses (RNs) with home care experience.

Admission: To be admitted to an AHHA Training Program, each candidate must: (1) have a high school diploma or similar credential; (2) be listed in New York State’s Home Care Worker Registry as a certified home health aide; (3) have at least a year of home care experience; (4) have English language and basic math skills; and, (5) be 18 or older. All accepted students must be recently trained in or currently certified in CPR or Basic Life Support before starting AHHA coursework.

NOTE: Candidates will also need government issued identification (i.e., driver’s license, passport, Military ID) to enroll in an AHHA Training Program.

Curriculum: AHHA Training Programs include at least 125 hours of instruction, including classroom and skills lab training and RN supervised patient care training. The AHHA Training Program must teach about: performing advanced tasks (including medication administration); infection control; working with supervising RNs; patient communication; and, documenting care. It must also prepare students to take the New York State Medication Aide Certification Examination (MACE®). To graduate from an AHHA training program, a student must successfully demonstrate medication administration skills.

New York State Medication Aide Certification Examination (MACE®)

The MACE® is a written exam that tests whether a home health aide has requisite knowledge to administer certain medications under RN supervision. You must graduate from a New York State approved AHHA Training Program before you can sign up for the MACE®. You must pass the MACE® within 180 days from the date that you started the AHHA training Program. You will have two chances take the MACE® within that 180-day period. If you do not pass the MACE® within those 180 days, you will have to complete an AHHA Training Program again before you will be allowed to take the MACE® again.

New York’s Home Care Worker Registry

New York State’s Home Care Worker Registry is a database maintained by the New York State Department of Health (DOH), which contains the names of individuals who are certified as home health aides, personal care aides and AHHAs in New York State. It also includes the names of approved AHHA Training Programs. After NYSDOH verifies that a person qualifies as an AHHA, the person is listed on New York State’s Home Care Worker Registry as certified as an AHHA. New York State Home Health Aide (HHA) and AHHA certifications are valid for three years. The AHHA’s employer must renew his or her AHHA and HHA certification and pay the recertification fee.


Frequently Asked Questions

  1. What is an advanced home health aide (AHHA)? What does an AHHA do?

    Answer: An AHHA is a certified home health aide: (1) with additional home care experience and training; (2) qualified under New York State Law to perform “advanced tasks” under the direct supervision of an RN; and, (3) listed in New York State’s Home Care Worker Registry as an Advanced Home Health Aide or AHHA. An AHHA is not a nurse.

    An AHHA provides the same care that certified home health aides provide In addition, unlike a certified home health aide, an AHHA may perform “advanced tasks” for certain hospice and home care patients under RN supervision. The RN must assign the advanced tasks to the AHHA in writing. The AHHA and RN must work for the same hospice, home care services agency, or enhanced assisted living residence - and - provide care to their employer’s patients at home.

  2. Should an AHHA, while working or seeking work, refer to himself or herself as a “nurse”?

    Answer: No. An AHHA is not a licensed nurse. An AHHA cannot hold him or herself out or accept employment as a person licensed to practice nursing.

  3. What are advanced tasks?

    Answer: Advanced tasks are some (but by no means all) nursing tasks commonly performed by licensed practical nurses in a patient’s home. Here are some examples of advanced tasks:

    • Administering certain medications that are routinely taken by a patient. The medications must be given: by mouth, in the eye or ear, nasally, on the skin, vaginally, rectally or inhaled through the nose or mouth.
    • Giving injections of low molecular weight heparin or diabetes medications.
    • Giving emergency injections of epinephrine, naloxone, or glucagon.

    Advanced tasks do NOT include:

    • Deciding whether a patient needs to take an as needed/ PRN medication.
    • Administered medications through feeding tubes such as gastrostomy or nasogastric tubes.
    • Tasks involving the use of intravenous or subcutaneous infusion devices on a patient.
    • Tasks involving the use of a mechanical ventilator on a patient.
    • Tasks involving sterile technique, except for giving injections identified above.
    • Tasks involving professional nursing judgement
    • Tasks that are outside the scope of practice of a licensed practical nurse (LPN).

  4. What type of organization can hire AHHAs to perform advanced tasks and employ RNs to assign advanced tasks and supervise the AHHAs?

    Answer: The organization must be licensed or certified by the New York State Department of Health (DOH) to operate a hospice, an enhanced assisted living residence, a licensed home care services agency (LHCSA), a long-term home health care program (LTHHCP) or a certified home health agency (CHHA). If a company is licensed by DOH a to operate an adult home and a LHCSA, the company may employ an RN and AHHA to perform advanced tasks to the company’s LHCSA patients only (including LHCSA patients who live in the adult home).

  5. If an AHHA is employed by a New York State licensed home care services agency (LHCSA), can the AHHA perform advanced tasks for persons who are not patients of the LHCSA?

    Answer: No. The LHCSA may employ an AHHA to perform advanced tasks only for its LHCSA patients. An enhanced assisted living residence may employ an AHHA to perform assigned advanced tasks only for its residents who qualify for enhanced assisted living services. A hospice may employ an AHHA to perform advanced tasks only for its hospice patients at home.

    Note: AHHAs are NOT allowed perform advanced tasks in nursing homes, hospitals, or other medical facilities.

  6. Who assigns advanced tasks to AHHAs and supervises AHHAs?

    Answer: Only a New York State licensed RN can assign advanced tasks to an AHHA and supervise an AHHA who performs advanced tasks. The RN and AHHA must work for a New York State Department of Health (DOH) licensed or certified hospice, enhanced assisted living residence, or home care services agency – and – they must provide care to their employers’ patients at home.

    • AHHAs are not legally allowed to assign advanced tasks.
    • Patients and family members are not legally allowed to assign advanced tasks to AHHAs.
    • Licensed practical nurses are not legally allowed to assign advanced tasks or supervise AHHAs who perform advanced tasks.

  7. How do registered professional nurses (RNs) assign advanced tasks?

    Answer: Before assigning an AHHA to perform an advanced task for a new patient:

    • The RN completes a comprehensive nursing assessment to ascertain the patients’ health status and care needs and determine whether it is clinically appropriate to assign an AHHA to perform an advanced task for the patient. If it is, the RN ensures that the advanced task to be assigned is consistent with a physician's, nurse practitioner's or other prescriber's ordered care.
    • The RN verifies that the patient (or a person who can consent to care for the patient) consents to the care to be provided by the AHHA. Verbal consent is fine if a general consent form has been signed and is in effect. However, the RN should document that verbal consent was given.
    • The RN trains the AHHA to perform the advanced task for the patient. The RN must verify that the AHHA can safely and competently perform the advanced task and can communicate well with the patient.
    • The AHHA must consent to perform the advanced task to be assigned for the patient.
    • The RN must provide the AHHA with written, patient specific instructions for performing the advanced task and criteria for identifying, reporting and responding to problems, errors or complications.
    • The RN documents the assignment of advanced task(s) to the AHHA in the patient’s health record.

  8. How do registered professional nurses (RNs) supervise advanced home health aides?

    Answer: The supervising RN provides training, guidance, and direction to an AHHA and assigns, voids or modifies assignments of advanced tasks, as needed. The supervising RN must be available to help the AHHA, as needed. If the supervising RN is not at the same location as the AHHA, the RN must be available to speak with the AHHA by phone, at a minimum. A supervising RN must visit the patient at least once every two weeks or more frequently, as needed, to assess the patient, provide care and supervise the services provided by the AHHA by, among other things, personally observing, evaluating and overseeing the provision of services by the AHHA. If an AHHA is assigned to perform any advanced task for a patient during a shift, a qualified RN must supervise the AHHA whenever the AHHA provides any service for the patient during the entire shift.

  9. What is the AHHA’s role in the assignment and performance of advanced tasks?

    Answer: Before an RN assigns an advanced task to an AHHA:

    • The AHHA is trained by the RN to perform the advanced task for the patient.
    • The AHHA receives from the RN written instructions on performing the advanced task and identifying, reporting and responding to problems.
    • The AHHA must agree to perform the advanced task to be assigned for the patient. The AHHA should not agree to perform the advanced task, unless the AHHA believes that he or she can perform the assigned advanced task safely and competently.

    Before performing an assigned advanced task, the AHHA should review the instructions for performing the task. The AHHA must perform the assigned advanced task in accordance with the written instructions and while under RN supervision. The AHHA must document care provided in the patient’s record. The AHHA must be able contact his or her supervising RN, as needed. If the supervising RN is not at the same location as the AHHA, the supervising RN must be available by phone, at a minimum.

    The AHHA should not perform an advanced task if the patient (or a person who can consent for the patient) refuses the care from the AHHA or if the AHHA is unable to perform it safely. In a non-urgent situation, if something goes wrong while providing care, the AHHA should follow written instructions from the delegating RN for handling the problem or contact the supervising RN for further instructions. In an emergency (such as when a patient unexpectedly and suddenly loses consciousness), the AHHA should call 911 immediately.

  10. How can I find out more about advanced home health aides?

    Answer: The New York State Advanced Home Health Aide (AHHA) Handbook For Students and Certified AHHAs December 2018 and additional information is on the New York State Department of Health website.

  11. What is a New York State approved AHHA Training program?

    Answer: New York State approved AHHA Training Programs teach home health aides how to perform advanced tasks while under RN supervision. An AHHA Training Program includes a minimum of 125 hours of instruction, including classroom and skills lab training and RN supervised patient care training. All home health aides must complete a New York State approved AHHA Training Program to qualify for certification as an AHHA. The AHHA Training Program must teach about: performing advanced tasks (including medication administration); infection control; working with supervising RNs; client communication; and, documenting care. It must prepare students to take the New York State Medication Aide Certification Examination (MACE®). To graduate from an AHHA training program, a student must successfully demonstrate medication administration skills.

  12. Which organizations are allowed to offer New York State approved AHHA Training Programs?

    Answer: The New York State Education Department (SED) approves the following types of organizations to offer New York State approved AHHA Training Programs.

    • Proprietary schools
    • Boards of Cooperative Educational Services (BOCES)
    • Adult Education, Educational Opportunity Centers
    • Colleges & Universities

    The New York State Department of Health approves the following types of organizations to offer New York State approved AHHA Training Programs.

    • Certified home health agencies (CHHAs)
    • Long term home health care programs (LTHHCPs)
    • Licensed home care services agencies (LHCSAs)
    • Hospices

  13. Where do eligible organizations apply for State Education Department (NYSED) approval to offer an AHHA Training Program?

    Proprietary schools should apply to:

    NYSED’s Bureau of Proprietary School Supervision
    Education Building, Room EBA 560
    89 Washington Avenue
    Albany, NY 12234
    Phone: 518-474-3969
    E-Mail: bpss@nysed.gov

    Boards of Cooperative Educational Services (BOCES) entities and adult programs should apply to:

    NYSED’s Career and Technical Education
    Education Building, Room 315
    89 Washington Avenue
    Albany, NY 12234
    Phone: 518-486-1547
    E-Mail: EMSCTEC@nysed.gov

    Colleges, Universities and Adult Education, Educational Opportunity Centers should apply to:

    Office of the Professions
    Professional Education Program Review
    Education Building, 2nd Floor West Wing
    89 Washington Avenue
    Albany, NY 12234
    Phone: 518-486-2967
    E-Mail: OPPROGS@nysed.gov

  14. What are the admission requirements for New York State Approved AHHA Training Programs?

    Answer: To be admitted to an AHHA Training Program, each candidate must: (1) have a high school diploma or similar credential; (2) be listed in New York State’s Home Care Worker Registry as a certified home health aide; (3) have at least a year of home care experience; (4) have English language and basic math skills; and, (5) be 18 or older. All accepted students must be recently trained in or currently certified in CPR or Basic Life Support before starting AHHA coursework and have government issued photo identification.

    NOTE: Candidates will also need government issued identification (i.e., driver’s license, passport, Military ID) to enroll in the AHHA Training Program.

    NOTE: Some AHHA Training Programs have additional admission requirements.

  15. What type government issued identification do I need to qualify as an AHHA?

    Answer: You will need government issued identification, such as a New York State driver’s license or U.S. Passport, to enroll in an AHHA Training Program and to take the New York State Medication Aide Certification Exam (MACE®). The government issued identification must be in English, include your photograph and signature and must NOT be expired. Your name on the government identification and your name in New York State’s Home Care Worker Registry MUST MATCH EXACTLY. If it does not, you might not be allowed to enroll in an AHHA Training Program or take the MACE®.

  16. How can I learn more about Advanced Home Health Aide Training Programs?

    Answer: New York State’s Advanced Home Health Aide Training Program Guide December 2018 and additional relevant information is available on the New York State Department of Health website.

  17. What is the New York State Medication Aide Certification Examination (MACE®)?

    Answer: The MACE® is a written exam that tests if home health aides have the required knowledge to administer certain medications under RN supervision. You must graduate from a New York State Approved AHHA Training Program before you can sign up for the MACE®. You must pass the MACE® within 180 days from the date that you started the AHHA training Program. You will have two chances pass the MACE® within that 180-day period. If you do not pass the MACE® within the 180 days, you will have to complete an AHHA Training Program again before you will be allowed to take the MACE® again.

  18. How do I sign-up to take the New York State Medication Aide Certification Examination (MACE)?

    Answer: Pearson VUE is a non-profit company that offers the MACE® at locations throughout New York State. To sign-up and pay the $80 fee to take the MACE®, visit www.pearsonvue.com/MACE/NY or call (888) 252 8564. After Pearson VUE verifies that you qualify to take the MACE®, Pearson VUE will notify you by regular mail or EMAIL and give you a candidate number. You must have a candidate number to schedule an appointment with Pearson VUE to take the MACE®.

  19. How can I learn more about the New York State Medication Aide Certification Examination (MACE®)?

    Answer: Visit Pearson Vue’s website at www.pearsonvue.com/MACE/NY

  20. What is New York State’s Home Care Worker Registry?

    Answer: New York State’s Home Care Worker Registry is a database maintained by the New York State Department of Health. It contains the names of persons who are certified as advanced home health aides, home health aides and personal care aides and the names of New York State approved AHHA Training Programs.

    For more information on New York State’s Home Care Worker Registry, visit https://www.health.ny.gov/.

  21. How do I change my address or name on New York State’s Home Care Worker Registry?

    Answer: For more information on changing your name or address on New York State’s Home Care Worker Registry, visit https://www.health.ny.gov/.

Last Updated: May 16, 2019