Nature of the Work:
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. Most homemaker-home health aides, however, work with elderly or disabled clients who require more extensive care than spouse, family, or friends can provide informally.
Job duties as well as schedules vary according to clients' needs. A person recuperating from major surgery may require daily care for a period of days or weeks, while someone with a chronic condition is likely to need help several times a week over an indefinite period of time. Homemaker-home health aides perform light housekeeping chores: Cleaning a client's room, kitchen, and bathroom; doing the laundry; and changing bed linens. Aides may also plan meals, including special diets, shop for food, and prepare meals.
Among the personal care services that aides perform are assisting with bathing or giving a bed bath, shampooing hair, and helping the client move from bed to a chair or another room. Homemaker-home health aides also check pulse and respiration, help with simple prescribed exercises, and assist with medications. Occasionally, they may change no sterile dressings, use special equipment such as a hydraulic lift, or assist with braces or artificial limbs.
Homemaker-home health aides also provide instruction and psychological support. For example, the home health aide may assist in toilet training a severely mentally handicapped child and work with the parents in reinforcing the training. Providing emotional support and understanding is a particularly important aspect of the work since a client's progress in regaining strength and independence may be greatly influenced by his or her mental attitude. Lastly, if employed by an agency, the aide reports changes in the client's condition and helps a professional team decide when the services being given to the client should be changed.
In agency settings, homemaker-home health aides are as-signed specific duties by a supervisor, usually a registered nurse, physical therapist, or social worker. If the care is medically related, the supervisor consults the client's physician about the need for in-home services, especially if the client recently has been discharged from the hospital. Many homemakers, home health agencies, both public and private, require that a physician certify that such services are necessary.
Before the aide starts coming to the client's home, the supervisor pays an initial visit to determine what specific services are appropriate and to discuss the aide's scheduled duties with the client, in many agencies, the aide is expected to submit a daily report, signed by the client, that lists the exact services performed and the hours worked. The supervisor visits the client regularly to be sure that the service is satisfactory.
If the supervisor determines that extensive services will be required over a long period of time, attempts are made to coordinate the assignment of the aide with other community and in-home services such as adult day care, meals-on-wheels, friendly visitors, and telephone reassurance. If satisfactory provision for the required care cannot be made, the supervisor may suggest an alternative arrangement such as transfer to a nursing home or retirement residence. However, in many cases, it is possible to maintain care in the home through the services provided by homemaker-home health aides, coordinated, when needed, with other community services.
The amount of variety in a homemaker-home health aide's daily routine depends on whether the aide assists one client or many. The job can entail going to the same home every day for months or even years. More commonly, however, aides work with a number of different clients, each job lasting a few days or weeks. Sometimes, aides go to two or three clients in the course of a single day.
Since aides assist clients in their own homes, surroundings differ from case to case. One home may be neat, while another may be untidy. Likewise, one case may be emotionally draining because the client is angry, abusive, or mentally confused, while another may be enjoyable because the client is so pleasant to be with.
Homemaker-home health aides are essentially on their own when they are at work. Although aides sent out by agencies generally have detailed instructions as to what services are to be performed, which clients are to be visited, and when these visits are to take place, it is up to the aide to carry out the instructions. Ordinarily, there is little direct supervision while the worker is in the client's home.
Aides are usually required to furnish their own transportation. Often, this means having access to an automobile. In any event, it is the aide's responsibility to find a way to get to the client's home on time. Aides may spend a good portion of the working day traveling from one client to another.
Full-time, part-time, and shift work is available for homemaker-home health aides. An attractive element of this job is that aides are often able to arrange their schedules to meet their personal needs.
Most homemaker-home health aides are employed by public or private agencies, including homemaker-home health agencies, home health agencies, visiting nurse associations, hospitals, public health and welfare departments, and temporary help firms. Self-employed aides have no agency affiliation or supervision, and accordingly accept clients, set fees, and arrange work schedules on their own.
Although only a small number of men currently are employed in the occupation, additional men are needed to care for men who prefer a male aide. The demand for male homemaker-home health aides has increased significantly with the advent of AIDS hospices that have a large proportion of male patients.
Training, Other Qualifications, and Advancement:
The minimum requirement for a homemaker-home health aide is to be able to read and write. A high school diploma is desirable, but not necessary. Most agencies require some formal training.
Subjects taught include 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; normal range of motion and positioning; and basic nutrition. Programs may be offered by the employing agency, the American Red Cross, a community college, or a vocational school, but they must meet the approval of the Health and Human Services Department. Some training programs may vary depending upon State regulations.
Many agencies offer in-service training opportunities for staff members. Workshops or lectures may be scheduled on specialized topics such as caring for clients with AIDS or Alzheimer's disease.
Successful homemaker-home health aides are mature persons who like to help people and don't mind hard work. They have a sense of responsibility, compassion, emotional stability, and a cheerful disposition. Aides must be tactful and able to get along with all kinds of people. Since aides work in private homes, they must also be honest and discreet. Clients may not want their medical problems or personal habits made public knowledge.
In addition to these personal qualities, homemaker-home health aides must be in good health because some of their duties, such as lifting, moving, and supporting patients, require above-average physical strength. A physical examination including a chest X-ray may be required.
As aides take on a variety of cases, they develop expertise in caring for persons with many types of illnesses. Some aides discover a special talent for caring for a specific type of client, such as those suffering from Parkinson's disease, and in some larger agencies, experienced homemaker, home health aides can specialize in caring for clients with a specific type of problem. After gaining experience in different types of cases, aides can assume more responsibility and become more self-directing within the scope of their assigned duties.
Employment of homemaker-home health aides is expected to grow much faster than the average for all occupations through the year. Changing demographics will play a major role in this growth. The number of people in their eighties and beyond is projected to rise substantially. This age group is characterized by mounting health problems that require some assistance. Another factor expected to stimulate demand for homemaker-home health aides is the increasing reliance by health professionals on home care for patients of all ages.
This trend reflects several developments: Efforts to contain costs by moving patients out of hospitals as quickly as possible; the realization that treatment in familiar surroundings can be more effective than in clinical surroundings; and the development of portable equipment for home use. For example, newborn babies with jaundice now can be treated at home with portable phototherapy equipment, and homemaker-home health aides will be needed to help their parents to take care of these infants as well as other home duties.
The extent to which these growth factors are translated into jobs for home care workers will depend on other things, however notably the availability of public and private funds to purchase in-home services; trends in informal caretaking by family, friends, and neighbors; and the role of alternative arrangements, including adult day care and life care communities.
Concern about the cost of hospital care has set in motion a number of important changes in the way such care is delivered and paid for. Pressure to reduce the length of hospital stays, for example, has spurred demand for home health services for patients recovering from stroke, surgery, and other serious conditions. The use of home care for patients upon their discharge from the hospital is expected to expand substantially, due in part to coverage for such care by Medicare, Medicaid, health maintenance organizations, and private health insurance plans.
Job prospects are excellent for people seeking work as homemaker-home health aides. In addition to new jobs created by the growth and aging of the population and new home technology, replacement needs are expected to produce numerous job openings. Turnover is high, a reflection of the relatively low skill requirements and low pay. Also contributing to turnover are the emotional demands this kind of work imposes.
Providing personal care and performing home management duties in a client's home can be quite stressful if the client is terminally ill or has an abrasive personality. Moreover, if no other family members are present, the work can be isolating. Aides who lack the temperament or maturity for handling difficult interpersonal situations are likely to leave the occupation. However, persons who are interested in this work and suited for it should have no trouble finding and keeping a job. Individuals with prior experience or training as homemaker-home health aides or nursing aides should find employment opportunities abundant and will be in great demand.
Earnings for homemaker-home health aides vary considerably. Some aides start at the minimum wage. Employees can pay workers younger than 20 years a lower training wage for up to 6 months. Homemaker-home health aides in agencies in large cities that have high living costs generally pay higher wages. Agencies that have union contracts usually pay higher wages and offer more benefits. While some agencies pay the same rate to all aides, most agencies give slight pay increases as aides gain experience and are given more responsibility.
Benefits vary even more than wages. Some agencies offer no benefits at all, while others offer a full package of holidays, vacation, sick leave, health and life insurance, and a retirement plan. While some agencies hire only on-call hourly workers, with no benefits, many agencies also employ aides on a full-time or part-time basis with many benefits and a minimum number of hours guaranteed. A typical full-time aide is guaranteed 36 hours of work a week; has 1 to 3 weeks of paid vacation each year, based on number of years of employment; earns 1 day of sick leave a month; is paid for major holidays; and can participate in health insurance and pension plans.
A typical part-time employee works a regular schedule and usually works at least 20 hours a week, receives the same hourly wage as full-time employees, and may have prorated benefits. A few agencies also prorate vacation and sick leave for those employees who do not have a guaranteed minimum number of hours or a regular schedule.
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, orderlies, physical therapy aides, playroom attendants, and psychiatric aides.