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Home Health Aides: On the Front Lines of Caregiving

Many adult children want to do the caregiving themselves but are simply unable to step away from their lives for this often full-time job. So what do you do?
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One recent morning, David Sanchez arrived at the Manhattan home of Professor Acton, just as he had done every morning for nearly seven years. David, who spends 12 hours a day six days a week caring for the 87-year-old retired professor, knew something was wrong the instant he stepped inside and did not hear the familiar greeting that usually started his mornings, a cheerful "David, you're here!" from within the apartment.

He rushed into the bedroom, only to find the vulnerable professor wedged dangerously between the bed and the wall, unable to move. David, who has more than seven years of experience as a home health aide, quickly and carefully made the professor safe and comfortable, and checked for injuries. Good, he thought, none were visible. But he could see that something else was amiss: Professor Acton's lips were severely chapped, he was disoriented and his skin was hot. David knew that meant the professor was dehydrated, a serious condition in an 87-year-old, and one that needed immediate attention.

So David did what so many talented home health aides across America do every day. Working on a solid foundation of expertise, trustworthiness and compassion, David assured Professor Acton that he was in good hands, and made the call to get him the medical attention he needed to get back on track and return home safely.

The "Stuff" of Daily Life

If you are the son or daughter of an aging parent who needs assistance, you may well be daunted by the choices before you. Many adult children want to do the caregiving themselves but are simply unable to step away from their lives for this often full-time job. So what do you do? Do you turn to someone recommended by a friend? Do you place, or answer, an ad in the newspaper? Do you contact an agency for home health aides who have been well trained and carefully vetted?

As Americans live longer -- and those with chronic debilitating conditions increasingly do remain at home -- we as a society are becoming more familiar with the job description of a home health aide. More and more of us count on them, the folks who come into our home, or the home of a loved one, to provide assistance with recovery from a recent injury, illness or surgery, or to help when chronic illness or disability becomes a debilitating condition. Home health aides provide companionship and help with shopping. Often they do the cooking, dressing, laundry, bathing and toileting for someone who can't manage on their own, and they help manage medications.

Although home health aides provide assistance with all the "stuff" of daily life, the job of a home health aide cannot and should not be done by just anybody -- contrary to all-too-popular belief. Trained home health aides are highly skilled, compassionate caregivers; every day they man the vital front lines of healthcare for vulnerable seniors and others who are not stable enough to be on their own. These talented aides are the best offense for keeping at-risk individuals out of the hospital and living safely and as comfortably as possible in their own homes.

Barometers of Health

As president of Partners in Care, a licensed, not-for-profit agency that provides certified home-care assistance throughout the New York metropolitan area, I have seen again and again how an expert pair of eyes and a caring set of hands can make all the difference in the world.

A good home health aide knows that daily activities -- bathing, dressing, eating, sleeping -- are really barometers of health. Subtle changes may indicate deteriorating health or issues with medication.

  • If a patient is eating less or sleeping more than usual, do medications or dosages need adjusting?

  • If the patient did not previously need help dressing and now does, has his or her condition degenerated?
  • If a patient is refusing to bathe, are there emotional issues that need addressing?
  • A well-trained home health aide is much more likely to notice changes in a patient's behavior or well-being and act immediately and appropriately, as David did with the retired professor he cared for. I am a strong advocate for rigorous screening and training of home health aides, and I find it unconscionable that regulations for this life-or-death industry vary state by state (including, woefully, none in some states). New York has relatively strict requirements for certification -- a minimum of 75 hours of training -- and my agency requires even more, at 114 hours. That includes specialized training in caring for people with HIV/AIDS, multiple sclerosis and Parkinson's disease, an increasingly important part of the job description and one I will discuss in a later post.

    Building Trust

    Rigorous training is also valuable in helping agencies identify candidates who are truly committed and well-suited to home care, meaning they are compassionate, attentive and reliable. As David is. And Frankie Fisk -- who cares for Peter Travers, a young man with a hereditary degenerative condition that leaves him unable to eat, dress, bathe or get through the day unassisted. The two still remember when their bond was tested several years ago during the massive citywide transit strike. Peter couldn't sleep the night before the strike, worried that Frankie would not be able to make the trip from his East Harlem apartment to Peter's apartment in the West 60s. And Frankie, knowing how anxious Peter would be, woke up at 5 a.m., took a cab as far as the strike limits would allow, walked the rest of the way -- and arrived for his shift one hour early.

    Even with well-trained and compassionate aides, client trust does not always come easily. Patients -- who in addition to being ill, injured or in declining health are often fearful of losing their independence and privacy -- may well resist a home health aide initially. With the right mix of persuasiveness and warmth, of training and good instincts, a good aide reassures a patient and explains how the aide's presence in the home increases, rather than compromises, a client's dignity by enabling him or her to live safely at home rather than moving into a nursing home or other facility.

    Valma, a seasoned aide who has been with Partners in Care for more than 25 years, still recalls her first day with one client, many years ago: "She saw me coming and said, 'Don't bother to come in. Don't come in here, I don't want anybody.'" Valma reassured her, "I'm not going to do anything that you don't want me to do. Anything you see me doing that you don't want, you can just tell me." By the end of the four-hour shift, Valma knew she had "worked some kind of magic," and the two remained together until the client passed away several years later.

    "They might not think they like me when I first come in," Valma continues, "but give me two days and we become good friends."

    If you have had a home health aide in your life, or in the life of a loved one, tell us about your experience. What are the most important qualities you look for -- or have found -- in a home health aide?