Competency Assessments for Home Care Personnel
By: Becky Tolson, RN, BS
Manager, Survey Operations
Posted: June 13, 2025
Home care agencies provide services that range from companion/homemaker support to skilled care and specialized therapies. The agency’s clients or patients should have confidence that tasks are performed appropriately by individuals in relevant roles. ACHC Standard HC4-6A supports agencies in meeting this expectation. The standard comes from the section on Human Resource Management and requires a competency assessment program for all direct care personnel.
Each individual’s role and responsibilities come with specific tasks. Competency assessment validates the skills associated with each job title. Assessment may be further focused on services assigned to be provided by an individual based on their level of experience and need for direct supervision. The standard requires that initial competency assessments be conducted during orientation, prior to providing a new task, and at least annually.
The standard allows for flexibility in the way competency assessment is accomplished. Direct observation, skills lab review, supervisory visits, knowledge-based testing, situational analysis of case studies, and self-assessment are all appropriate means of evaluation. Note however, that a self-assessment tool is not acceptable as the only form of evaluation.
Despite this flexibility, ACHC’s 2024 Surveyor, Quality Review edition found that HC4-6A was cited as a deficiency for 18% of home care agencies surveyed.
What’s being missed?
“There was no competency testing completed or onsite assessment of the aide’s skills at the time of hire or since.”
This example represents an ACHC Surveyor’s finding of noncompliance with the standard.
A common theme in deficiencies is incomplete policies and procedures. The requirement for competency assessment may be missing entirely, or the timing of initial and ongoing assessment may not meet the standard. Surveyors also noted inadequate documentation in personnel files to clearly link competency assessment to specific tasks associated with the direct patient care role.
Tips for compliance
- Develop policies and procedures that incorporate all required components, including times when competency assessments must be conducted.
- Audit personnel records for complete documentation of competency assessments specific to the direct care job title, tasks, and responsibilities.
- Ensure that personnel in appropriate roles are performing the competency assessments.
- Create a plan to address performance and education when competency requirements are not met.
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Read more articles about Home Care Accreditation here.