Home health agencies enlist the service of aides to spend several hours a day in the homes of the frail elderly handling many of these types of tasks, thus allowing the patient to remain living at home and to retain a certain level of the freedom and independence they have valued their entire lives.

The problem with this type of care is fundamental, not systemic. These agencies, as well as the various legislators that govern and fund their function, are simply too ignorant of the true needs of the people they care for and are sworn to protect.

Agencies are always understaffed, and because aides are not required to obtain more than the simplest of training, the agencies do not pay enough to attract the services of professional health care workers. Instead, many are staffed by uneducated housewives looking to make a few extra bucks, not career minded professionals looking to help people truly in need. And when I say a few extra bucks, I really mean a few – typical pay scale for a home health aide is between $8.00 and $12.00 per hour. The variance between the top and bottom of this pay scale depends on the level of certification the aide achieves on his/her own AND (believe it or not) the brand of insurance coverage carried by the patient. Different insurance companies allow these agencies to bill them at different rates for the same services, thereby paying the attending aides different rates per job assignment; a pay scale determined solely upon the brand name of the insurance company each patient carries.

Typically, aides are provided for patients anywhere from 3 to 12 hours per day depending on the needs of the patient as they are assessed by actual medical professionals and social workers.

In and of itself, this sounds like a good program that just needs a little tweaking, But when you live in the day to day grind with a frail family member as I have, and functioned as their primary caregiver, the not so blatant flaws become abundantly clear and quickly!

First, I have nothing against the people of the home health care agencies or their staffs of aides. the majority of the hard working people who travel to these patients’ homes, change diapers, bathe, cook and clean for them, do it all for a beggars pittance and are truly an asset to their profession, and should never be disparaged for their efforts. Most perform virtually life saving tasks and establish very close, personal mutual bonds with the people they care for. My only point with them is that they simply lack the training in proper care to provide a high enough level of attention during those infrequent times of higher distress that, while extreme to the patient, don’t necessitate a call to 911, (which is pretty much all they are trained for and allowed to do by law). That being said, there are a minority of aides out there that truly have no business caring for any human (or even a cat, for that matter). Fortunately those are in the minority, however, I mention it here only to express the need for greater diligence in the home health agency hiring/screening process for new applicants.

The biggest and most common issue faced in the home health care arena though is probably the most fundamental and timeless of all issues: when people are making at or close to minimum wage, they have a tendency to put life’s daily obstacles ahead of their jobs. If they decide they don’t want to go to work today, many just don’t. They have little fear of losing their jobs when, let’s face it, they could get another job at McDonald’s making at least as much and not having to change diapers. Once they make the choice to take a day off, the few that bother to call, never do so early enough for an agency to find a replacement aide; and of course, that’s even if they bother to call at all. This happens MUCH more frequently then you could ever imagine and when it does, it can place the lives of the neglected patients in imminent danger. If there is no local family support system, these people are left to fend for themselves when many can’t even stand up on their own, let alone cook, bath or make it to the toilet. Consequently, (and this is not some crazy one in a million scenario – it happens EVERYDAY somewhere in America), the patient is left to stew in their own fluids, starve, and sit totally helpless, in most cases while being as fully alert and aware as they were when they were in their youth. This, in my opinion, is the greatest tragedy that faces the home health industry today. The physical consequences, stress and turmoil suffered by the often helpless patients is so severe that it should seriously be considered as a criminal act. In reality, however, this happens every single day and usually needs to be done three times by an aide before her job is even in serious jeopardy. That, is a travesty in the most extreme sense of the word.

Before you say, “oh, it must have just been a bad agency or isolated incident,” guess again. In the 12 years my mother received home health care, she was serviced by a total of 8 different agencies, located in 3 different geographical areas, and it happened numerous times with each, precipitating me to relocate 1,400 miles across the country to care for her so she wouldn’t be faced with the only other alternative — a nursing home.

So what is the alternative? It’s great to point out deficiencies in policies and agencies that exist in all manner of life, but what can we do to effect change?

While I don’t for a minute pretend to have all the answers, I do know a few ways you can protect yourself or your senior family members and minimize the risk you and your family face from bureaucracy and unscrupulous home health care workers. The answer to the biggest parts of the home health care dilemma is: to register with a local adult day care facility!

If you’ve never heard of adult day care, I’m not surprised. Neither had I until I began my frantic search for relief from a seemingly merciless home health care system, but I detail everything you need to know about adult day care in my article: “What is Adult Day Care and is it Right for Us?”

Adult Day Care adds a vital extra level to the stages of progression between being a fully independent citizen and needing the services of a residential nursing home or intermediate care facility.

The question of when the transition to a residential facility is in the best interest of a senior or disabled adult is often the topic of highly contested debate. In recent years, it has almost become a trend to deposit “grandma” into a residential facility when she loses the ability to fully provide for her own needs; typically when chores such as toileting, bathing, cooking and cleaning become too physically daunting to be handled independently.

The most important thing you need to know now is: You are NOT alone in your quest for better and more reliable senior care! There are many people, like myself, who have endured it, learned our lessons the hard way, and are now more than willing to share what we’ve learned with you. Nobody should have to endure the futility and hardship of being alone or seeing someone they love being neglected either directly or indirectly. And whether the intent to neglect is there or not, is merely an academic argument as far as I am concerned.

Rather than looking to point fingers, call names, or sling mud (as frustrated and eager to do so as we might be) it’s most important to remain focused on the ultimate prize: getting better care for ourselves or our seniors before it’s too late and they are forced to suffer any (or any more) of the indecencies mentioned earlier in this article.

For more information, please read: “What is Adult Day Care and is it Right For Us?” as I spell out where to look; what to do; who to contact; and how to contact them to get you on the road to less stressful care. There is no quick fix to home health care woes, but there are things you can do to get you and your family on the path to easier times. I will endeavor to highlight many of them for you in each successive article on this and related topics.

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Dorian Lassiter is 39 years old and is the author of many comprehensive and informative articles, short stories and novels. As an only child, he functioned as primary caregiver to his single mother during the last dozen years of her life. That life ended sadly on October 17, 2010, at the age of 64, when she finally succumbed to emphysema and COPD after a valiant 12 year battle.