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Healthcare assistants and care workers

Healthcare assistant jobs abroad: UK, Ireland, EU, US (2026)

Healthcare assistants and care workers are not a registered profession in the UK or Ireland, but visa rules, employer requirements and, in Germany, the Netherlands and the USA, state recognition or certification still decide where you can work.

Overview

Healthcare assistants (HCAs), care assistants and care workers support patients and residents with personal care, observations, mobility, eating and drinking, under the direction of nurses.

Across the five countries MedicSail covers, the role is treated in very different ways. In the UK and Ireland it is not a statutory registered profession: there is no regulator to apply to, and employers decide whom to hire. In Germany, the Netherlands and the USA, assistant-level care roles are regulated by law or by state certification, so a foreign qualification has to be recognised or you have to pass a state exam.

For the UK, the immigration rules matter more than registration. GOV.UK lists occupation code 6131, nursing auxiliaries and assistants, among the codes eligible for a new Health and Care Worker visa application with an approved NHS or care employer. Care workers and home carers (code 6135) and senior care workers (code 6136) are different: GOV.UK says they can only be used to extend, update or switch to a Health and Care Worker visa, not for a new application from overseas. GOV.UK's eligible occupations table classes 6131 as medium skilled, and its immigration salary list says that for sponsorship the code only applies to roles in settings where registered nurse or other registered healthcare professional roles also exist. Since 11 March 2024, most people sponsored as care workers or senior care workers cannot bring a partner or children, and since 22 July 2025 similar limits apply to new workers in medium skilled jobs such as 6131.

Ireland's HSE employs health care assistants on a national pay scale and usually asks for a QQI Level 5 major award in a relevant health skills area, or an equivalent qualification from another jurisdiction. Non-EEA workers need an employment permit, and the Department of Enterprise set a minimum salary of €32,691 for healthcare assistants and home carers from 1 March 2026.

Germany is changing its system now. Until the end of 2026, nursing assistant training is set by each federal state, with 27 different state rules. From 1 January 2027 a single federal profession, Pflegefachassistenz, starts with 18 months of full-time training, and the Federal Ministry of Health says foreign qualifications will be recognised through a knowledge test or adaptation course rather than a full equivalence check. In the Netherlands, the verzorgende in de individuele gezondheidszorg (VIG) is a protected title under the BIG Act, recognised for non-EU diplomas through the Certificate of Professional Competence. In the USA, certified nursing assistants (CNAs) complete a state-approved programme of at least 75 hours and pass a state competency evaluation to join the state nurse aide registry.

This page explains each route, what the visa rules say as GOV.UK currently states them, and what changes if you trained as a nurse but plan to start as an assistant, including if you work in the Gulf today.

Qualifications

Minimum

UK: NHS Health Careers says there are no set entry requirements, although employers usually expect good literacy and numeracy and some care experience. Ireland: the HSE usually asks for a QQI Level 5 major award in a relevant health skills area or an equivalent qualification from another jurisdiction. Germany, the Netherlands and the USA: a recognised assistant qualification or state certification.

Preferred

A formal care qualification with supervised placements, such as a nursing assistant certificate or diploma, plus first aid and basic life support. In the UK, new HCAs complete the Care Certificate's 16 standards; in the Netherlands, a qualification comparable to the Dutch VIG diploma.

Experience

Paid or voluntary care experience is generally expected in the UK. Some HSE posts accept candidates who have started a relevant QQI Level 5 course and commit to completing it within 18 months. In Germany and the Netherlands, professional experience can help offset gaps in training.

Country by country

United Kingdom: No statutory register

Healthcare assistant, care assistant, care worker (not protected titles)

Requirements
No regulator registers HCAs or care workers. Employers set requirements and usually provide induction against the Care Certificate's 16 standards. In England, the Care Quality Commission regulates care providers, not individual workers.
Exams
None. The Care Certificate is completed at work, and NHS Employers says it should be finished within 12 weeks of starting.
English
Set by the employer. For a Health and Care Worker visa, GOV.UK requires English at CEFR level B2, for example through an approved Secure English Language Test.
Timeline
No registration step. A visa decision depends on the sponsor and GOV.UK processing.
Good to know
Code 6131 (nursing auxiliaries and assistants) is eligible for new Health and Care Worker visa applications, but only for roles in settings where registered nurses or other registered healthcare professionals also work. Codes 6135 and 6136 (care workers, senior care workers) are only for extending, updating or switching.
Working in the United Kingdom

Ireland: No statutory register

Health care assistant (not a regulated title)

Requirements
There is no register for HCAs; CORU and NMBI do not regulate the role. HSE eligibility criteria usually require a QQI Level 5 major award such as Health Service Skills or Healthcare Support, or an equivalent qualification from another jurisdiction.
Exams
None set by a regulator.
English
Set by the employer.
Timeline
No registration step. Non-EEA nationals need an employment permit before starting work.
Good to know
From 1 March 2026, the minimum salary for an employment permit for healthcare assistants and home carers is €32,691, according to the Department of Enterprise.
Working in Ireland

Germany: State recognition authority

Pflegehelfer/in or Pflegeassistent/in (state law, until 2026); Pflegefachassistenz (federal, from 1 January 2027)

Requirements
Until 31 December 2026, assistant nursing training is regulated by each federal state, and the state authority decides on recognition of a foreign qualification. From 1 January 2027 the federal Pflegefachassistenz replaces the 27 state rules with 18 months of full-time training.
Exams
Under the new federal law, the Federal Ministry of Health says foreign qualifications will be recognised through a knowledge test or an adaptation course instead of a full equivalence check.
Language
German, not English, at the level needed for practice. The state authority sets which certificate it accepts.
Timeline
Set by the state authority. A knowledge test or adaptation course adds time.
Good to know
Ask the authority whether your application will be decided under the old state rules or the new federal law, because the change takes effect on 1 January 2027.
Working in Germany

Netherlands: BIG

Verzorgende in de individuele gezondheidszorg (VIG): protected title under the BIG Act, without BIG registration

Requirements
VIG is one of the professions with a legally protected title that cannot be entered on the BIG register. With a diploma from outside the EU or Switzerland, you apply through mijn.bigregister.nl for a Certificate of Professional Competence, and the CBGV committee compares your training with the Dutch diploma.
Exams
No BI-test. The committee may require additional training, an adaptation internship or a practical skills test.
Language
Dutch at B1 through the State Examination of Dutch as a Second Language (NT2), less than two years old. The BIG register says VIG applicants do not need to prove English reading skills.
Timeline
The BIG register says six to 18 months on average; without a BI-test you receive an intended decision within six weeks of your file reaching the committee.
Good to know
The certificate procedure is free. Once recognised, you may work under the VIG title without BIG registration.
About the BIG registerWorking in the Netherlands

United States: State nurse aide registries

Certified nursing assistant (CNA) or nurse aide, certified by each state

Requirements
Federal rules for nursing homes require a state-approved training programme of at least 75 clock hours, including at least 16 hours of supervised practical training, followed by a competency evaluation. Those who pass are entered on the state nurse aide registry.
Exams
Many states use the National Nurse Aide Assessment Program (NNAAP): a written exam of 70 multiple-choice questions in two hours (or an oral version) plus a skills evaluation.
English
No national English test. The exam is in English unless the state offers alternatives.
Timeline
Training programmes are short, but each state sets its own rules for people trained abroad.
Good to know
There is no national route that recognises a foreign HCA qualification. The BLS median wage for nursing assistants was $42,260 in May 2025.
Working in the United States

The route, step by step

  1. 1. Decide which role you are applying for

    Healthcare assistant, care worker, VIG and CNA are different roles with different rules. If you are a qualified nurse, check the nursing route first: working as an assistant can be a stepping stone, but it does not register you as a nurse anywhere.

  2. 2. Check the visa or work permit rules before anything else

    In the UK, GOV.UK lists code 6131 for new Health and Care Worker visa applications, while care worker codes 6135 and 6136 are not open to new applicants from overseas. In Ireland, check the employment permit rules and minimum salary. Never pay anyone for a care job offer or a certificate of sponsorship.

  3. 3. Get your qualification documents in order

    Ask your school or college for your certificate, transcript and a breakdown of theory and placement hours. Germany and the Netherlands need certified copies and sworn translations, and the Dutch committee compares your course with the VIG diploma.

  4. 4. Prove your language

    For a UK Health and Care Worker visa, GOV.UK requires English at B2, for example through an approved Secure English Language Test. Germany needs German at the level the state authority sets, and the Netherlands needs NT2 at B1 for VIG.

  5. 5. Apply for recognition or certification where it exists

    In Germany, apply to the state authority for recognition and be ready for a knowledge test or adaptation course. In the Netherlands, apply for a Certificate of Professional Competence. In the USA, check your state's nurse aide registry rules for training and the competency evaluation.

  6. 6. Secure a job with an eligible employer

    UK sponsors must be the NHS, an organisation providing NHS services or adult social care, and care providers in England must be registered with the Care Quality Commission for care worker roles. In Ireland, check that the employer can support a permit at the required salary.

  7. 7. Complete induction and keep training

    In the UK, complete the Care Certificate within the time your employer sets. Keep records of your training, as they count towards apprenticeships, nursing associate training or nursing degrees later.

Exam preparation

Most HCA routes have no licensing exam. The exceptions are Germany, where a knowledge test may be set for foreign qualifications, the Netherlands, where the committee may require a practical skills test, and the USA, where CNAs must pass a state competency evaluation such as the NNAAP written or oral exam and skills evaluation. In the UK, the Care Certificate's 16 standards are the best guide to what employers expect from new staff.

Tips

  • Read the Care Certificate standards before UK interviews; they describe exactly what a new HCA is expected to know.
  • Practise the core skills step by step: hand hygiene, personal care, safe moving and handling, and taking observations.
  • Learn how to report and escalate concerns to the nurse in charge, a common interview and exam scenario.
  • For the NNAAP skills evaluation, practise each skill aloud, including checking identity, privacy and infection control steps.
  • For a German knowledge test, prepare in German, including care documentation and terms used in care homes and hospitals.
  • Revise safeguarding of adults and children, which UK and Irish employers test at interview.
  • Keep your basic life support training current; many employers ask for it.
  • In the Netherlands, prepare for a possible committee interview in Dutch about your training and placements.

Topics that come up

  • Personal care, privacy and dignity
  • Infection prevention and control
  • Fluids, nutrition and feeding support
  • Moving, handling and falls prevention
  • Vital signs and observations
  • Communication and person-centred care
  • Dementia, mental health and learning disability awareness
  • Safeguarding adults and children
  • Basic life support and first aid
  • Health and safety at work
  • Recording and handling information
  • Role boundaries and escalating to nurses

Pay by country

The UK, Ireland and the USA publish official pay figures for this role. In Germany and the Netherlands pay is set by collective agreements or employers, and we have not invented figures.

  • UK£25,272 (Band 2), 2026/27NHS Agenda for Change in England from 1 April 2026. NHS Health Careers says HCAs typically enter at Band 2. Care home pay is set by the employer.
  • Ireland€36,651 to €45,939 (Health Care Assistant), from 1 June 2026HSE consolidated pay scales, grade code 6075. The employment permit minimum for healthcare assistants and home carers is €32,691 from 1 March 2026.
  • GermanySet by collective agreement or employerWe could not confirm figures from an official source. Trainees under the new Pflegefachassistenz law receive training pay.
  • NetherlandsSet by the sector collective agreement (CAO) or employerWe could not confirm figures from an official source. Ask which CAO applies.
  • USA$42,260 median annual wage for nursing assistants (May 2025)US Bureau of Labor Statistics. Orderlies: $38,290.

Career growth

Assistant roles are a common entry point to health careers. Each country has a clear next step for people who want to progress.

  1. Senior healthcare assistant

    NHS Health Careers says HCAs can progress to senior HCA roles, often with extra clinical skills such as phlebotomy or ECGs.

  2. Assistant practitioner or nursing associate

    In England, HCAs can train as assistant practitioners or nursing associates. Nursing associates are registered with the NMC.

  3. Registered nurse

    With the right qualifications, HCAs can move into nursing degrees or apprenticeships.

  4. Specialist support roles

    Maternity care assistants, theatre assistants and therapy assistants all sit within the same UK occupation group (6131) and offer specialist experience.

  5. Other health professions

    NHS Health Careers notes that HCAs with suitable qualifications can move into degree-level roles such as midwifery, podiatry or occupational therapy.

Common mistakes

  1. 1

    Paying an agent for a UK care worker job or certificate of sponsorship. Care worker and senior care worker codes are not open for new Health and Care Worker visa applications from overseas.

  2. 2

    Assuming every care job in the UK is sponsorable. Check the occupation code with the employer against the GOV.UK list.

  3. 3

    Planning to bring family on a UK care worker visa. Since 11 March 2024 most new care workers and senior care workers cannot sponsor dependants, and since 22 July 2025 similar limits apply to medium skilled jobs such as 6131.

  4. 4

    Applying to Irish posts without a QQI Level 5 major award or an equivalent. A component certificate does not meet HSE criteria.

  5. 5

    Missing the German change on 1 January 2027. Check with the state authority whether your case falls under the old or the new rules.

  6. 6

    Learning Dutch to the wrong level or with an unaccepted test. VIG needs NT2 at B1, less than two years old.

  7. 7

    Using a nursing qualification to apply as a VIG or HCA without checking the nursing route first; you may qualify for more.

  8. 8

    Assuming a foreign certificate makes you a CNA. In the USA you must meet your state's training and competency evaluation rules to be on the registry.

How we help healthcare assistants and care workers

  • Review of your qualifications, transcripts, experience and current registration

  • Check against the published requirements of the regulators you choose

  • Check of how recent your practice is and whether any gap in practice affects your route

  • English or other language requirement for each route, with any exemption you may qualify for

  • Comparison of routes and countries, with the trade-offs explained

  • List of the exams, aptitude tests or adaptation periods each route is likely to involve

  • Written roadmap: exams, English test, documents, fees and timeline

  • Budget built from the official regulator, exam and verification fees, kept separate from our own fee

  • Flags for slow steps to start first, such as primary source verification and language learning

  • A call to walk you through the plan and answer your questions

What our eligibility assessment includesPackages and fees

Questions

No. Healthcare assistants and care workers are not regulated professions in the UK, so there is no register. Employers set requirements, and new staff usually complete the Care Certificate.

GOV.UK says care workers and home carers (code 6135) and senior care workers (code 6136) can only be used to extend, update or switch to a Health and Care Worker visa. If you are switching from another visa, you must have worked legally for your sponsor for at least 3 months.

GOV.UK lists code 6131, nursing auxiliaries and assistants, among the occupation codes eligible for a new Health and Care Worker visa application. GOV.UK's immigration salary list says the code only applies to roles in settings where registered nurse or other registered healthcare professional roles also exist. You need a job offer from an approved employer, a certificate of sponsorship and pay that meets the salary rules. Because 6131 is classed as medium skilled, GOV.UK limits when you can bring a partner or children.

GOV.UK requires English at CEFR level B2. You can prove it with an approved Secure English Language Test, certain UK qualifications, or a degree taught in English confirmed by Ecctis.

GOV.UK says care workers and senior care workers can only bring a partner or children if they meet a listed condition, such as having been employed in the UK in the role on a sponsored visa since before 11 March 2024.

HSE posts usually require a QQI Level 5 major award in a relevant area such as Health Service Skills, Healthcare Support or Nursing Studies, or an equivalent qualification from another jurisdiction. Check the eligibility criteria in each job advert.

The HSE scale for Health Care Assistant runs from €36,651 to €45,939 from 1 June 2026. The employment permit minimum salary for healthcare assistants and home carers is €32,691 from 1 March 2026.

It is the new federal nursing assistant profession that starts on 1 January 2027, with 18 months of full-time training. It replaces 27 different state rules, and foreign qualifications will be recognised through a knowledge test or adaptation course.

A verzorgende in de individuele gezondheidszorg is a protected title under the Dutch BIG Act. With a non-EU diploma you apply for a Certificate of Professional Competence and need Dutch at B1; English reading skills are not required for VIG.

Each state sets its own rules for nurse aide training and testing. Federal rules require a state-approved programme of at least 75 hours, or an equivalent the state accepts, and a competency evaluation before you are entered on the state registry.

No. A licence from the DHA, DOH, MOHAP, SCFHS or QCHP does not transfer. In the UK and Ireland employers judge your experience directly; in Germany and the Netherlands your qualification itself must be recognised.

It can be. In England HCAs can train as nursing associates or nurses through apprenticeships or degrees. Working as an assistant does not register you as a nurse.

Sources

  1. 1GOV.UK: Health and Care Worker visa, your job
  2. 2GOV.UK: Health and Care Worker visa, your partner and children
  3. 3GOV.UK: Health and Care Worker visa, knowledge of English
  4. 4GOV.UK: Health and Care Worker visa, how much it costs
  5. 5GOV.UK: Skilled Worker visa immigration salary list (code 6131 condition)
  6. 6GOV.UK: Skilled Worker visa eligible occupations and codes
Show all 21 sources
  1. 7NHS Health Careers: Healthcare assistant
  2. 8NHS Employers: Care Certificate
  3. 9NHS Employers: Pay scales for 2026/27
  4. 10HSE: Health Care Assistant Home Support eligibility criteria (South West)
  5. 11HSE: Consolidated pay scales, 1 June 2026 (PDF)
  6. 12Department of Enterprise: Employment permit minimum salary changes (December 2025)
  7. 13Federal Ministry of Health: Pflegefachassistenzeinführungsgesetz
  8. 14Federal Ministry of Health: Bundestag passes Pflegefachassistenz law (press release)
  9. 15BIG register: Other professions (protected titles)
  10. 16BIG register: Certificate of Professional Competence
  11. 17BIG register: Dutch language skills and English reading skills
  12. 18BIG register: Processing time and costs
  13. 1942 CFR 483.152: Requirements for approval of a nurse aide training and competency evaluation program
  14. 20Credentia: The 2024 National Nurse Aide Assessment Program (NNAAP)
  15. 21BLS Occupational Outlook Handbook: Nursing assistants and orderlies

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