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Home Health Aides: The Front Lines of the Future

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When Sandra Santos*, who is frail and elderly, fainted in her kitchen, her home health aide Angela knew just what to do, calling 911, initiating CPR, and remaining calm throughout. "She didn't leave my mother's side," marveled Mrs. Santos's daughter. "She handled the situation until help arrived and continued to be professional and level-headed. My family and I were very lucky to have her with our mother that day."

To Mrs. Santos's family, Angela feels like a rare find.

For an aging nation -- and a home health aide industry expecting stratospheric growth over the next decade -- we must ensure that people like Angela and the care she delivers are not so rare.

An Urgent Need

Trained home health aides are skilled, compassionate caregivers who work on the front lines of health care for vulnerable seniors and others who are not stable enough to be on their own. At the agency where I work, aides are part of a nurse-led care team that helps keep at-risk individuals out of the hospital and living safely and as comfortably as possible in their homes. They help with cooking, dressing, laundry, bathing, toileting and other activities of daily living.

As the 65-and-over population balloons from 40 million people in 2010 to 72 million in 2030, and people increasingly choose to age at home, often with multiple chronic conditions, we will experience an urgent need for home health aides in the coming years. The U.S. Department of Labor projects that over the next decade 1.3 million home health aides will be added to the workforce (for an increase of 70 percent since 2010). That's like adding the entire population of San Antonio, Texas, the nation's seventh largest city, to the roles as home health aides.

Our agency, Partners in Care -- already the largest licensed home care service agency in New York -- doubled in size in the last eight years, growing from nearly 5,000 aides serving 4,500 clients in 2004 to more than 10,300 aides today, serving nearly 9,200 clients. We recently built a new training facility in Lower Manhattan last year to accommodate burgeoning need. There is robust demand on both sides of the equation: potential workers looking for training and jobs, especially in a lackluster economy, and potential clients needing a qualified aide to help them live safely at home.

Beyond the Numbers

The numbers are indeed staggering, but the need goes well beyond the numbers. We need 1.3 million of the right people: well-trained, fairly compensated and given the tools, opportunities and support to advance in health care fields. We must train them not only so they can perform an excellent job on the front lines of day-to-day health care, but also so they have a stake in being part of the solution for our aging population. A multi-pronged strategy is needed, including:

Increasing specialty training

We must grow strategically, to ensure supply aligns with demand that increasingly includes customized care for people aging at home with dementia, diabetes, congestive heart failure, multiple sclerosis, HIV/AIDS, Parkinson's, and other chronic, debilitating illnesses. At Partners in Care, we include many hours of specialty training in our initial 114-hour training and during daylong in-service training for working aides, which might include a module on safe care for patients with memory loss or wheelchair transfers for MS patients.

We recently piloted a program to train a select group of aides in physical therapy skills, better positioning them to care for rehabilitating patients. Specialty training gives an aide valuable skills that can translate into greater employability, more work hours, and, if our industry helps build a pipeline, into eventual career advancement.

Developing career advancement

Home health aide positions are typically entry level, offering both opportunity (a first job for new immigrants, for example) and limitations (low wages and insufficient career advancement). We as an industry must do all we can to boost wages for these dedicated care providers, and we must develop channels to foster advancement in health-related fields. I take great personal and professional pride in a number of our aides who have studied to become registered nurses.

Our agency is exploring ways to create pipelines for advancement. We recently introduced a group of hand-selected aides to non-clinical assessment skills, which diversifies their skills set and could expand job possibilities. While the nature of home health aide work -- dispersed throughout individual households -- creates a challenge in developing mentoring programs, we are investigating ways to encourage aides to take full advantage of the teams with which they serve, which include registered nurse supervisors, social workers, rehabilitation therapists and dieticians. By learning about and developing varied skills, home health aides not only position themselves better in the job market but also play a vital role in advancing much-needed home- and community-based care for an aging nation.

Working in partnership

Innovative partnerships are critical if we are to develop a responsive home health aide workforce in all the communities where seniors are aging in place. An aide who lives in New York City, for example, could spend as much time traveling to a two-hour shift in suburban Long Island or Westchester County as she does working the shift. We have recently partnered with the community group LI-CAN(Long Island Congregations Associations and Neighborhoods) to expand training and support of home health aides to care for aging, homebound Long Islanders. We are looking into using local congregation spaces as training spaces and are working with LI-CAN to explore and enhance public transportation options.

Investing in employees

As we recruit, screen, train and support a million-plus home health aides for these vital jobs at the front lines of health care, we must develop an atmosphere of professionalism and high expectations. In conjunction with the Paraprofessional Health Institute (PHI), our agency has been training home health aide supervisors to give constructive, productive feedback and create a workforce driven by trust and mutual respect.

The home health aide business is, after all, a relationship business -- as the family of Mrs. Santos well knows. "Angela gives 110 percent," says Mrs. Santos's daughter (to protect privacy, we have changed the family's surname). "She acted professionally, lovingly, and, most of all, cared for our mother with respect and dignity." Not a bad model for shaping one of the fastest-growing workforces of the future.

*Mrs. Santos name has been changed for privacy reasons.

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