Introduction The increased growth of older adults has generated demand for home care aides (HCAs). Occupational tobacco smoke exposure (OTSE) may risk their health that should be paid attention to. This study explored the HCAs’ perspectives of OTSE to inform health promotion programs catering to individual needs. Methods A two-stage Q methodology was employed for data collection and analysis. 39 Q statements were extracted in the first stage and then 51 HCAs with OTSE were recruited to complete Q sorting in the second stage. PQ Method software was used for data analysis. Principal component analysis was performed to determine the most appropriate number of factors. Results The five factors identified from HCAs’ perspective of OTSE explained 51% of the variance. The HCAs agreed that OTSE could increase cancer risk. The HCAs with Factor I did not care about OTSE, tending to complete their work. The HCAs with Factor II agreed the health hazards of OTSE, but did not know how to help their clients stop smoking. The HCAs with Factor III cared about OTSE but were afraid of disrupting the client-provider relationship. The HCAs with Factor IV regarded OTSE as a priority for occupational interventions whereas the HCAs with Factor V did not think OTSE was an issue and believed that they could balance work and OTSE health hazards. Conclusions Our findings will inform the design of home care pre-service and on-the-job training courses. Long-term care policies should be developed to promote smoke-free workplaces. Implications There are five types of home care aides’ perspective on occupational tobacco smoke exposure (OTSE). The tailor interventions can be developed to help them avoid the OTSE (e.g., opening windows for ventilation or using air purification equipment) and have an OTSE-free spaces