By Rona S. Bartelstone, LCSW, BCD, CMC
One day, as Mrs. Jones was dressing Mr. S, she
bent down to help him with his shoes and her back
froze in place. She was unable to straighten up. She
managed to creep to the phone to call a friend for
help, but she had to insist that Mr. S not move out
of her sight for fear that he would wander off.
Mrs. Jones had found herself being treated in the
rehabilitation facility in which she used to work.
The doctor told her that she would not be able to
work as an aide again. As she got stronger, Mrs.
Jones filed for worker's compensation and disability
insurance.
Once again, the government became aware of the
employment situation in which the injury occurred
and they pursued the family for medical expenses and
for disability coverage. This cost the family many
times more than it would have if they had the
appropriate insurances or if they had worked through
a licensed home health agency.
Abuse and Exploitation
Unfortunately, there is the potential for both
physical abuse and financial exploitation when work
is being done on behalf of a frail, functionally
limited, and often cognitively impaired individual.
While most individuals who become home health aides
do so out of a desire to help others and to
contribute to the community, there will always be
those who see this type of work as an opportunity to
take advantage of someone. This becomes especially
easy when the aide and the recipient of care are
isolated in a private home setting with little or no
supervision.
Families don't fail to provide supervision out of
malicious neglect. Supervision is often difficult
because of geographic distance, lack of expertise,
or the close emotional bonds that often get
established between the aide and the person
receiving the care. Furthermore, families often do
not have the time or the resources to do criminal
background checks, or to contact references, if they
even think to ask for references. Sometimes families
are so grateful for the care provided by an aide
that they are also vulnerable to manipulation and
exploitation.
Agency Supervision
A licensed home care agency has
a responsibility to provide ongoing supervision for
their employees. This includes helping the aides to
understand the changing needs of clients, assuring
the proper limits of care according to the practice
acts of the various levels of professionals, and
mediating difficult relationship issues.
Providing supervision is often as important for the
aide as it is for the family. Home health aides
often work with very challenging situations in the
isolation of the private home situation. There are
often issues of different cultural and faith
traditions, different expectations about personal
schedules, eating preferences and expectations. An
agency supervisor can help to clarify the roles of
the home health aide, and the expectations of both
worker and care recipient. Furthermore, the agency
can support the aide in setting appropriate limits
on the types of care that can be provided. For
example, an older adult might expect an aide to help
with dressing changes or high tech care that is
legally the responsibility of a licensed nurse.
