12/01/2011 08:09 am ET | Updated Jan 31, 2012

Home Health Aides: Who Is Caring for You or Your Loved One?

Every day across the United States, health aides walk into the homes of people in need, often people who live alone and are unable to take care of themselves, whether they are recovering from illness or injury or require long-term assistance to remain at home.

By the year 2050, the number of Americans who need long-term care is expected to nearly double, according to a recent National Health Statistics Report (NHSR) from the Centers for Disease Control and Prevention. Though most of this care will be provided by unpaid family members, the need for care provided by home health aides is expected to increase dramatically as America ages and people live longer. The NHSR cites projections that employment of home health aides will rise by 50 percent between 2008 and 2018 -- from 921,000 to 1,382,000.

Who are the people to whom we entrust our aging parents, our spouses, ourselves in our greatest need, and how can we ensure that they are a good fit for our loved ones? The first questions I would ask center on background checks, training and compatibility -- to ensure your or your loved one's safety and security. If you are hiring from an agency, these are the questions I recommend asking:

1. What kind of background searches do you run?

2. What kind of experience and training do the aides have?

3. What bases of compatibility will you use to select my aide?

I have written previously about the ins and outs of background checks and the training that licensed aides receive, and how that qualifies them for their role on the "front lines" of health care. In this post, I'd like to look at where aides come to us from, their motivations for entering the field, their sources of strength amid the challenges of providing companionship and assistance in the activities of daily life.

The Demographics

To begin, the profession is overwhelmingly female -- 95 percent nationwide (our agency, Partners in Care, is similar, at 99 percent). Many aides entered the field because they have cared for someone, often in their family, and find they are good at it -- a reason cited by some 77 percent of aides nationwide, according to the NHSR's comprehensive survey, published in May. That report also found aides get into the field for pragmatic reasons: 80 percent say jobs are available close to home; 76 percent percent say the jobs are steady and secure.

Being a home health aide often serves as an entry-level position for new immigrants to the United States. This is particularly true in New York. Some 35 to 40 percent of Partners in Care's home health aides were born outside the United States, mirroring the demographics of a melting-pot city in which 36 percent of the population is foreign-born. Our demographics differ, however, from nationwide statistics: the NHSR survey found that nearly 90 percent of all home health aides are U.S. citizens by birth.

When Pauline Smith immigrated to New York from Jamaica in 1993 and began looking for work, she was, foremost, pragmatic. "I needed a job," she said, "and I found one as a home health aide. That's where it started." She also tapped a history of caring that began in her teenage years when she looked after her aging grandmother. "I had a deep desire to care for someone," says Pauline, who's been working as a home health aide since 1997. "I'd been through that coming up, caring for my grandparents, my own parents. I like caring for people who are not able to take care of themselves. That kind of satisfaction grew on me."

Beyond the Numbers: Compassion

Certified aides who work for licensed agencies have a toolbox of skills and knowledge acquired in training -- at least 75 hours in agencies across New York State (regulations vary by state). These caregivers have references and a clean track record that can withstand rigorous background checks on the state and federal level. But there is more to it than that.

"The training can teach them how to be a good home health aide," says my colleague Jay Conolly. "But it can't teach them how to be a good human being. This is an incredibly hard job, physically, emotionally. It takes a lot of strength. As a group and individually, they are wonderfully loving, caring, responsible, understanding and certainly patient."

"Compassion," answers longtime home health aide Jennifer Paul, when asked what it takes to be successful in her job. It is an answer we hear again and again from our aides -- and from their patients. "Here's what it is: being yourself, loving what you do, and loving your patients," she says.

She also emphasizes being a good listener. She is mindful that people she cares for are not only physically challenged but also often highly frustrated, stripped of their independence and privacy. "When you go into someone's home, you have to give them a little space," she explains. "Don't just take over. Listen -- really listen -- to what they want."

If the plan of care says a patient should get up at 6 a.m., for instance, but he or she really prefers to get up at 8 or 9, talk to the nurse about revisiting the plan of care. "If a patient really doesn't like something, I try to understand what they're saying and see if we can't work accordingly," says Jennifer.

She derives satisfaction and strength from a job well done, which she often achieves early in the day. "When they've had breakfast, had their medication, are bathed and dressed, and I've tidied up -- everything is nice and clean and fresh," she describes with pride. "I feel I've helped them get back to themselves."

Measuring Success

For Pauline, who cares for hospice patients in their final weeks and months, success is measured differently. She bathes, dresses, feeds and provides companionship to her patients, but she knows she is not helping them get "back to themselves." "Satisfaction comes from knowing, at the end of the day, that you have done everything possible to make this person comfortable for that day," she says. "Each day, I thank the Lord that I am healthy today and able to take care of someone who ultimately will pass away. I do it wholeheartedly. You have to, if you're going to do it."

She recalls one hospice patient to whom she read every day from the newspaper and the Bible. At first, they would have robust conversations about the reading material. As he grew weaker, he became unable to talk -- but she still read every day. "When I saw his face light up, I knew he was still hearing and enjoying. I knew I was still making a difference in his life."

Pauline is not alone in experiencing job satisfaction from being a home health aide. It is fairly common knowledge that compensation for home health aides is low -- certainly not commensurate with the difference it can make in people's lives. But what may be less well known is how satisfied the vast majority of aides are with their jobs. The national survey found that nearly 85 percent of aides say they would take their current job again, and virtually all aides (96.5 percent) say they felt their work was very important.

Communication and Consistency

When you hire a home health aide for an aging parent, a spouse or another loved one, you should expect a person who is compassionate, caring, well trained and knowledgeable -- which is why I recommend hiring an aide who is insured, certified and properly trained. Beyond this, there are two essential ingredients to a successful relationship: communication and consistency. This is where you can play a vital role.

Establish and maintain a professional relationship with the home health aide. Although this is an intimate relationship, it is still an employer/employee relationship. A professional aide will expect such boundaries, and you will feel much better about the relationship. If there are cultural behaviors and traditions that a home aide needs to know, communicate them early on. Maintain a close channel of communication with the aide and, if you hire an agency, with the aide's supervisor. Communicate any questions, concerns or issues as soon as they come up, either to the aide or her supervisor.

Our goal -- and, I think, the goal of any good home care -- is consistency, in this case, the same home health aide each day service is needed. If the patient and the home health aide develop a trusting and caring relationship, it means better communication, better care, and ultimately better well-being for your loved one.