Homemaker-Home Health Aides

• Nature of the Work

  Homemaker-home health aides help elderly, disabled, and ill persons live in their own homes instead of in a health facility. Most work with elderly or disabled clients who need more extensive care than family or friends can provide. Some homemaker-home health aides work with families in which a parent is incapacitated and small children need care. Others help discharged hospital patients who have relatively short-term needs. These workers are sometimes called home care aides and personal care attendants.

  Homemaker-home health aides provide housekeeping services, personal care, and emotional support for their clients. They clean clients' houses, do laundry, and change bed linens. Aides may also plan meals (including special diets), shop for food, and cook.

  Home health aides provide personal care services, also known as "hands on" care because they physically touch the patient. These aides help clients move from bed, bathe, dress, and groom. They also check pulse, temperature, and respiration; help with simple prescribed exercises; and assist with medication routines. Occasionally, they change nonsterile dressings, use special equipment such as a hydraulic lift, give massages and alcohol rubs, or assist with braces and artificial limbs. Some accompany clients outside the home, serving as guide, companion, and aide.

  Homemaker-home health aides also provide instruction and psychological support. For example, they assist in toilet training a severely mentally handicapped child or just listen to clients talk about their problems. Aides keep records of services performed and of the client's condition and progress.

  In home care agencies, homemaker-home health aides are supervised by a registered nurse, a physical therapist, or a social worker, who assigns them specific duties. Aides report changes in the client's condition to the supervisor or case manager. Homemaker-home health aides also participate in case reviews, consulting with the team caring for the client—registered nurses, therapists, and other health professionals.

• Working Conditions

  The homemaker-home health aide's daily routine may vary. Aides may go to the same home every day for months or even years. However, most aides work with a number of different clients, each job lasting a few hours, days, or weeks. Aides often go to four or five clients on the same day.

  Surroundings differ from case to case. Some homes are neat and pleasant, while others are untidy or depressing. Some clients are angry, abusive, depressed, or otherwise difficult; others are pleasant and cooperative.

  Homemaker-home health aides generally work on their own with periodic visits by their supervisor. They get detailed instructions explaining when to visit clients and what services to perform. Many aides work part time, and weekend hours are common.

  Most aides generally travel by public transportation, but some need a car. In any event, they are responsible for getting to the client's home. Aides may spend a good portion of the working day traveling from one client to another.

• Employment

  Homemaker-home health aides held about 598,000 jobs in 1994. Most aides are employed by homemaker-home health agencies, home health agencies, visiting nurse associations, residential care facilities with home health departments, hospitals, public health and welfare departments, community volunteer agencies, and temporary help firms. Self-employed aides have no agency affiliation or supervision, and accept clients, set fees, and arrange work schedules on their own.

• Training, Other Qualifications, and Advancement

  In some States, this occupation is open to individuals with no formal training. On-the-job training is generally provided. Other States may require formal training, depending on Federal or State law.

  The Federal Goverment has enacted guidelines for home health aides whose employers receive reimbursement from Medicare. Federal law requires home health aides to pass a competency test covering 12 areas: Communication skills; observation, reporting, and documentation of patient status and the care or services furnished; reading and recording vital signs; basic infection control procedures; basic elements of body function and changes; maintenance of a clean, safe, and healthy environment; recognition of and procedures for emergencies; the physical, emotional, and developmental characteristics of the patients served; personal hygiene and grooming; safe transfer techniques; normal range of motion and positioning; and basic nutrition.

  A home health aide may also take training before taking the competency test. Federal law suggests at least 75 hours of classroom and practical training supervised by a registered nurse. Training and testing programs may be offered by the employing agency, but they must meet the standards of the Health Care Financing Administration. Training programs vary depending upon State regulations. Thirteen States have specific laws on personal care services.

  The Foundation for Hospice and Home Care offers a National Homemaker-Home Health Aide certification. The certification is a voluntary demonstration that the individual has met industry standards.

  Successful homemaker-home health aides like to help people and do not mind hard work. They should be responsible, compassionate, emotionally stable, and cheerful. Aides should also be tactful, honest, and discreet since they work in private homes.

  Homemaker-home health aides must be in good health. A physical examination including State regulated tests like those for tuberculosis may be required.

  Advancement is limited. In some agencies, workers start out performing homemaker duties, such as cleaning. With experience and training, they may take on personal care duties. The most experienced aides assist with medical equipment such as ventilators, which help patients breathe.

• Job Outlook

  A large number of job openings is expected for homemaker-home health aides, due to very rapid growth and very high turnover. Homemaker-home health aides is expected to be one of the fastest growing occupations through the year 2005—more than doubling in employment size.

  The number of people in their seventies and beyond is projected to rise substantially. This age group is characterized by mounting health problems that require some assistance. Also, there will be an increasing reliance on home care for patients of all ages. This trend reflects several developments: Efforts to contain costs by moving patients out of hospitals and nursing facilities as quickly as possible; the realization that treatment can be more effective in familiar surroundings rather than clinical surroundings; and the development of portable medical equipment for in-home treatment.

  In addition to jobs created by the increase in demand for these workers, replacement needs are expected to produce numerous openings. Turnover is high, a reflection of the relatively low skill requirements, low pay, and high emotional demands of the work. For these same reasons, many people are unwilling to do this kind of work. Therefore, persons who are interested in this work and suited for it should have excellent job opportunities, particularly those with experience or training as homemaker-home health aides or nursing aides.

• Earnings

  Earnings for homemaker-home health aides vary considerably. According to a National Association for Home Care survey of home care aides who work in Medicare-certified agencies, beginning aides' average starting hourly wage ranged from $4.90 to $6.86 in May 1994. More experienced aides' average starting hourly wage ranged from $5.69 to $8.11. Wages were somewhat higher in the Northeast and West and somewhat lower in the Midwest and South. Some aides are paid on a salary or per-visit basis.

  Most employers give slight pay increases with experience and added responsibility. Aides usually are paid only for the time worked in the home. They normally are not paid for travel time between jobs. Most employers hire only "on-call" hourly workers and provide no benefits.

• Related Occupations

  Homemaker-home health aide is a service occupation that combines duties of health workers and social service workers. Workers in related occupations that involve personal contact to help or instruct others include attendants in children's institutions, childcare attendants in schools, child monitors, companions, nursing aides, nursery school attendants, occupational therapy aides, physical therapy aides, playroom attendants, and psychiatric aides.

• Sources of Additional Information

  General information about training and referrals to State and local agencies about opportunities for homemaker-home health aides, a list of relevant publications, and information on national certification are available from:
  Foundation for Hospice and Homecare/National Certification Program, 519 C St. NE., Washington, DC 20002.

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