Home health aides (HHAs) represent one of the fastest growing professional groups in the United States (Bureau of Labor Statistics, 2015), yet they are also one of the most underacknowledged and undervalued workforces in terms of their overall contribution. HHAs play a key role in enabling people who are in need of care to remain in the community rather than having to transition to an institutionalized care setting. This is important because the vast majority of older adults report staying in their current home as they age is their preference (Keenan, 2010).

HHAs provide one-on-one individualized care in the home, meaning that for the patient, daily schedules such as mealtimes can be flexible, and that many other aspects of daily care, activities, and interactions can be tailored to the patient's personal preferences. This aspect of home care makes it different from facility settings due to their structure, staffing, and scheduling requirements.

Because of the one-on-one context, HHAs have a chance to get to know their patients well and learn about their needs and preferences. As a result, they also typically develop very close relationships with their patients and their patients' families. In addition to the hands-on care, HHAs often provide important companionship and emotional support to patients. They can also contribute to patients' social connectedness in the community (e.g., by helping to set up and get to social encounters). In many ways, HHAs are the formal care counterpart to the informal caregiver, and as such they often become an extension of the family or, in case of little family availability, they may even become a kind of family substitute.

From a care delivery standpoint, HHAs play a critical role because they act as the "eyes and ears" of the healthcare system. No other member of the care team is present in the home consistently enough to allow for regular monitoring of the patient's status and to alert other care providers about emerging concerns. Similarly, they are the eyes and ears for family members who may not be able to regularly visit and check on their relative. Furthermore, with increasing frequency, HHAs see clients through the end of their life and may be present when the patient deteriorates, or even when they die. Notifying the agency and the family of the patient's death and comforting family members in the immediate aftermath of death are not unusual roles for HHAs. This is not a part of the basic job description for HHAs, and more often than not, they receive little preparation, support, and acknowledgment for the kinds of scenarios they encounter and then have to respond to in their work context. The degree to which the role of the HHA is respected, understood, and supported will have to change dramatically if the goal is to meet the rising long-term care needs and to be responsive to the general push toward maximizing community-based care options for the growing population of older adults who hope to "age in place."

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