Home health aide

Definition

Home health aides are members ofthe health care team who assistwith the provision of health care under the direct supervision and specific delegation of the licensed and credentialed health care professional.

Description

Home health aides provide assistance to elderly, convalescent, or disabled persons living in their own homes instead of in health care facilities. Most home health aides work with persons who need more extensive care than their family and friends can provide. They also work with recently discharged hospital patients who have relatively short term needs.

Home health agencies, nursing and residential care facilities, and social assistance agencies typically hire and assign home health aides to patients. An aide will work under the supervision of a registered nurse, physical therapist , or social workers. The supervisor will provide information on when to visit patients and what services to perform. Examples of health care services that the aide may provide include checking the patient's vital signs such as pulse, temperature and respiration rate, assisting with simple exercises, and helping the patient get in and out of bed, bathe, dress, and groom. They also can change non-sterile dressings, give massages and provide skin care, and assist with braces or artificial limbs. With additional training and experience aides may assist with medical equipment, such as ventilators . They may also help with activities of daily living, including light housework, preparation of meals, shopping for groceries, using the telephone, and entertainment of patients by talking, reading, or playing games or cards. They must also be able to respond to emergency situations and be knowledgeable of basic safety techniques.

The work can be physically demanding, with many hours spent standing, walking, and moving patients. Mechanical lifting devices are not usually available in patients' homes, so home health aides need to be careful to avoid injuries from moving and positioning patients. Home health aides are at risk for contracting infections and diseases and must take precautions to avoid these hazards. Home health aides also perform tasks that many consider unpleasant, such as emptying bedpans, collecting urine or stool specimens, or changing soiled bed linens.

Home health aides must be tactful, honest and discrete and act in a professional and courteous manner, as they work in private homes. They also should have a service orientation and be actively finding ways to help their patients. They need to be able to deal calmly and with good nature with patients who may be in pain , uncooperative, or depressed. They also need access to automobiles or public transportation to travel to patients' homes.

Ideally an agency providing home health care services should develop policies and procedures to:

• provide a backup if an aide does not show up
• provide a training program for aides
• maintain references for aides
• perform criminal background checks
• bond aides, to protect patients from theft losses
• provide worker's compensation to cover injuries that an aide might incur in a patient's home
• create, monitor, and modify care plans for individual patients
• ensure care plans are being implemented
• conduct on-site inspections of an aide's performance
• consult with patient and family concerning patient's progress

Work settings

Home health aides work in the patient's home, where other family members may also live. They may go to the same patient's home for long periods of time, or may work with several different patients for a few hours, days, or weeks. They often may visit five to six patients during a single day, spending one to two hours with each visit. They are responsible for travel to their patients' homes and may spend significant amounts of time traveling. Home health aides may also work in hospice situations, caring for patients who are dying .

Home health aides usually work alone, with periodic visits by their supervisors. They may work full-time, part-time, or on-call, depending on the needs of patients. They may also work evenings, weekends, and holidays.

In 2006 there were about 787,000 home health care aides in the United States. The number of jobs available for home health care aides is expected to grow by at least 28 percent from 2006 to 2016, as there will be a growing demand for health services from an aging population as well as pressure to contain medical care costs by moving patients from hospitals and nursing care facilities to their homes as quickly as possible. Patients often prefer to be cared for in their homes where they are more independent, comfortable, and where the costs are usually lower than in nursing homes . Improvements in home care medical technologies also make in-home care more possible.

The median hourly pay for home health aides was $9.34 in 2006. The middle 50 percent earned between $7.99 and $10.90 per hour; the lowest 10 percent earned less than $7.06 and the highest 10 percent earned more than $13.00 per hour. Home health aides employed by home health care services made $9.14 per hour while aides working for community care facilities for the elderly earned $8.87 per hour. Home health aides receive only slight pay increases with experience and added responsibility. They are usually only paid for the time they work in patients' homes and not for travel time between jobs; in some cases they must pay for their travel costs. Many home health aides are on-call hourly workers and do not receive job benefits. Because of these low pay rates, there is a high turnover of home health aides. Without additional education or formal training, advancement opportunities for home health aides are limited.

In 2005 the National Center for Health Statistics (NIHS) conducted a study referred to as the National Home and Hospice Study. Data were collected on 1.3+ million persons receiving home care in the United States. Almost 30 percent were under 65 years of age, while 70 percent were over 65 years old. About six to seven percent of the adults aged 65 needed help with activities of daily living (ADLs: bathing, dressing, transferring in and out of beds or chairs, using the toilet, eating and walking), while almost 21 percent of adults aged 85 or older needed help with ADLs. Between 65 and 85 more women than men needed help.

Care team role

Home health care aides provide direct bedside care to patients, under the supervision of registered nurses, physical therapists, or social workers employed by home health agencies. As direct care providers, they provide valuable information to patients' health care teams concerning their patients' physical, mental, and emotional conditions.

Education/Training

A high school diploma is generally not required for a position as a home health aide. Aides are usually trained on the job by registered nurses, licensed practical nurses, or by more experienced aides. Training may also be obtained in adult education programs in some private career schools and colleges. The patient may also have specific opinions on the way certain tasks should be completed and may make requests or suggestions to the aide. Some students work as home health care aides during their high school or college careers. They gain experience while they are attending school and also learn through experience whether to pursue a health care profession.

Specific qualifications and certification requirements vary by state laws and work setting. For example, in California, a high school diploma is not required, but home health aides must complete classroom and clinical training approved by the State Department of Health Services, Aide, and Technician Certification. Training topics include basic nutrition , meal planning and cooking, home cleaning tasks, and methods to bathe, turn and move patients. Aides also learn about behavioral characteristics of the elderly as well as ways to deal with emotional problems of patients caused by illness and aging. An aide must also provide a medical report stating that the aide can do the work without harm to self, patients, family members, or visitors, the results of a physical examination and testing for tuberculosis , and the results of a criminal background check. Also in California, home health aides must receive 12 hours of in-service training and a performance review annually by the health care agencies that employ them. Certification must be renewed every two years.

The National Association for Home Care and Hospice provides a voluntary certification program for home health aides. Certification is a voluntary demonstration that the individual has met industry standards. Certification requires the completion of a 75 hour course, observation and documentation of seventeen skills forcompetency assessed by a registered nurse, and successful completion of a written examination.

Family teaching

An important responsibility of a home health aide is to teach patients how to care for themselves in spite of their illness or disability.

KEY TERMS

Hospice —A program that provides special care for people in the final phase of illness, their families and caregivers. The care may take place in the patient's home or in a homelike facility.

Resources

BOOKS

American Medical Association. American Medical Association to Home Caregiving. Hoboken, NJ: John Wiley and Sons, Inc., 2001.

Fuzy, Jetta, and Leahy, William. The Home Health Aide Handbook, Second Edition. Albuquerque NM: Hartman Publishing, Inc., 2005.

Leahy, William, and Fuzy, Jetta. Providing Home Care: A Textbook for Health Aides. Albuquerque NM: Hartman Publishing, Inc., 2005.

Leahy, William. Workbook to Providing Home Care, 2nd Edition Albuquerque NM: Hartman Publishing, Inc., 2004.

ORGANIZATIONS

Direct Care Alliance, Inc., National Clearinghouse on the Direct Care Workforce, and Paraprofessional Healthcare Institute, 349 East 149th Street, 10th Floor, Bronx, New York, 10451, (718) 928-2063, (718) 585 6852, LVega@directcarealliance.org, http://www.directcarealliance.org; http://www.directcareclearinghouse.org/index.jsp; http://www.paraprofessional.org.

National Association for Home Care and Hospice, 228 Seventh Street, SE, Washington, DC, 20003, 202-547 7424, 202-547-3540, http://www.nahc.org/.

United Kingdom Homecare Association, Group House, 52 Sutton Court Road, Sutton, Surrey, United Kingdom, SM1 4SL, 020 8288 5291, 020 8288 5290, enquiries @ukhca.co.uk, http://www.ukhca.co.uk.

Judith L. Sims