Numerous job openings for nursing, psychiatric, and home health aides will arise from a combination of fast employment growth and high replacement needs. High replacement needs in this large occupation reflect modest entry requirements, low pay, high physical and emotional demands, and lack of opportunities for advancement. For these same reasons, many people are unwilling to perform the kind of work required by the occupation, limiting the number of entrants. Many aides also leave the occupation to attend training programs for other health care occupations. Therefore, persons who are interested in, and suited for, this work should have excellent job opportunities.

Overall employment of nursing, psychiatric, and home health aides is projected to grow much faster than average for all occupations through the year 2014, although individual occupational growth rates will vary. Home health aides is expected to be the fastest growing occupation, as a result of both growing demand for home services from an aging population and efforts to contain costs by moving patients out of hospitals and nursing care facilities as quickly as possible. Consumer preference for care in the home and improvements in medical technologies for in-home treatment also will contribute to much-faster-than-average employment growth for home health aides.

Nursing aide employment will not grow as fast as home health aide employment, largely because nursing aides are concentrated in slower growing nursing care facilities and hospitals. Employment of nursing aides is expected to grow faster than average for all occupations through 2014, in response to the long-term care needs of an increasing elderly population. Financial pressures on hospitals to discharge patients as soon as possible should boost admissions to nursing care facilities. As a result, job opportunities will be more numerous in nursing and residential care facilities than in hospitals. Modern medical technology also will drive demand for nursing aides because, as the technology saves and extends more lives, it increases the need for long-term care provided by aides.

Employment of psychiatric aides, the smallest of the three occupations, is expected to grow more slowly than average for all occupations. Most psychiatric aides currently work in hospitals, but most job growth will be in residential mental health facilities and in home health care agencies. There is a long-term trend toward treating mental health patients outside of hospitals because it is more cost effective and allows patients to live more normal lives. Demand for psychiatric aides in residential facilities will rise in response to growth in the number of older persons, many of whom will require mental health services, but also as an increasing number of mentally disabled adults, who were formerly cared for by their elderly parents, seek care. Job growth also could be affected by changes in government funding of programs for the mentally ill.

Nursing and psychiatric aides help care for physically or mentally ill, injured, disabled, or infirm individuals confined to hospitals, nursing care facilities, and mental health settings. Home health aides have duties that are similar, but they work in patients' homes or residential care facilities. Nursing aides, also known as nursing assistants, certified nursing assistants, geriatric aides, unlicensed assistive personnel, orderlies, or hospital attendants, perform routine tasks under the supervision of nursing and medical staff. They answer patients' call lights; deliver messages; serve meals; make beds; and help patients to eat, dress, and bathe. Aides also may provide skin care to patients; take their temperature, pulse rate, respiration rate, and blood pressure; and help them to get into and out of bed and walk. They also may escort patients to operating and examining rooms, keep patients' rooms neat, set up equipment, store and move supplies, and assist with some procedures.

Aides observe patients' physical, mental, and emotional conditions and report any change to the nursing or medical staff. Nursing aides employed in nursing care facilities often are the principal caregivers, having far more contact with residents than do other members of the staff. Because some residents may stay in a nursing care facility for months or even years, aides develop ongoing relationships with them and interact with them in a positive, caring way. Home health aides help elderly, convalescent, or disabled persons live in their own homes instead of in a health care facility. Under the direction of nursing or medical staff, they provide health-related services, such as administering oral medications.

Like nursing aides, home health aides may check patients' pulse rate, temperature, and respiration rate; help with simple prescribed exercises; keep patients' rooms neat; and help patients to move from bed, bathe, dress, and groom. Occasionally, they change nonsterile dressings, give massages and alcohol rubs, or assist with braces and artificial limbs. Experienced home health aides also may assist with medical equipment such as ventilators, which help patients breathe. Most home health aides work with elderly or disabled persons who need more extensive care than family or friends can provide. Some help discharged hospital patients who have relatively short-term needs.

In home health agencies, a registered nurse, physical therapist, or social worker usually assigns specific duties to and supervises home health aides, who keep records of the services they perform and record each patient's condition and progress. The aides report changes in a patient's condition to the supervisor or case manager. Psychiatric aides, also known as mental health assistants or psychiatric nursing assistants, care for mentally impaired or emotionally disturbed individuals. They work under a team that may include psychiatrists, psychologists, psychiatric nurses, social workers, and therapists. In addition to helping patients to dress, bathe, groom themselves, and eat, psychiatric aides socialize with them and lead them in educational and recreational activities.

Psychiatric aides may play games such as cards with the patients, watch television with them, or participate in group activities, such as sports or field trips. They observe patients and report any physical or behavioral signs that might be important for the professional staff to know. They accompany patients to and from examinations and treatment. Because they have such close contact with patients, psychiatric aides can have a great deal of influence on their patients' outlook and treatment.