The Personal Assistant - A New Option For Home Care

April 1995 – Caring Magazine
By Judith B. Clinco, R.N,

One adult home care agency has tapped middle-aged women as re-sources for home care aides—specifically as personal assistants. This approach has fine results and may prove a good model for addressing the normally high-turnover rate this position accrues.

As the population of the United States grows older, the need to provide home care services for aged, ill, or disabled seniors is exploding. There is an especially urgent need for cost-effective, trained, non-medical home care aides—a need that will continue to expand as the Baby Boomer generation ages.

The numbers tell the story: the adult home care industry created more than 75,000 new jobs in 1993. Those new jobs—a 17% increase over 1992—pushed the adult home care industry to the number-two spot for job growth, according to the US Bureau of Labor Statistics (BLS) (Biz Magazine 1994). The growth rate was second only to the rate of temporary employment agencies.

Even more growth is forecast. The BLS projects the creation of another 479,000 new jobs for adult home care aides by 2005, making it the fastest growing job category in the nation; during the same period another 166,000 new jobs will be created for personal care aides (Home Health Business Report 1994).

Many seniors need help with one or more activities of daily living (ADL). Although many clients are frail elders, the need for qualified adult home care exists in every part of the population. In 1993 more than 40% of the 8,066,000 Americans with disabilities were younger than 65 (Families USA Foundation 1993).

The Families USA study defined disability as “having difficulty with at least one activity of daily living.” The ADLs—bathing, dressing, toileting, feeding, and bed-chair transfers—are the five major skills of independent life for seniors. For many seniors, just getting a little help around the house can make the difference between living at home and a reluctant, upsetting, and often unnecessary move to a nursing home. Unfortunately, finding affordable, reliable, senior care services in the home can be a considerable problem.

Answering the Call

Some 64%, nearly two in every three, of all seniors with disabilities received no paid home care services in 1992 (Families USA Foundation). What help they did find came entirely from unpaid, informal caregivers, usually family members.

Why? In a word, cost. Because the needed senior services are often non-medical in nature, insurance companies and Medicare usually do not cover them. And for those living on a fixed income, there is not much money available to pay for care out of pocket.

The answer to this dilemma lies in the creation of a new category of adult home care aide: the personal assistant. Personal assistants are home care senior aides who fill the gap between homemaker-companion and nurse’s aide. Assisting with hygiene—particularly helping seniors into and out of the shower or bath—is the personal assistant’s most important role and the part of the job that sets it apart from the responsibilities of the homemaker-companion.
Other duties depend on the needs of the client.

The personal assistant might:

• Help with dressing and undressing
• Do the cooking, cleaning, and household chores
• Provide transportation and act as an escort

Providing nursing care is not part of the personal assistant’s job. Because they are not medically trained, personal assistants are available at lower cost than nurse’s aides.

Many adult home care agencies might already be placing caregivers with similar skills in their clients’ homes. One agency’s approach, however, emphasizes recruiting mid-life women.

Options and Costs

The senior who just needs a little help around the house has only a few options. Relying on a spouse or other family members is the most common solution. Or the senior can hire someone privately, hire through an agency, or call on a church or other community organization.

Beyond that, adult home care can get expensive in a hurry. Clients can choose:

• A live-in nurse’s aide at a cost of $130 to $160 a day
• Nursing homes, which cost nearly $100 a day for a semiprivate room and $150 or more a day for a private room
• An apartment in a senior retirement community with medical services available at a cost of $1,800 to $2,300 a month

Hiring a personal assistant is a cost-effective alternative. For a caregiver hired through an agency, $11-$12 an hour is about average; because the personal assistant works as many or as few hours as the senior needs, the placement can be very economical. It might mean just a few hours a day, or one morning or afternoon a week, to give the regular caregiver a bit of respite time. This arrangement allows the client to be an active partner in determining how much help he or she needs, encourages and supports continued independence on the part of the client, and helps contain the cost of care.

Preventing unnecessary hospitalizations is another way that a personal assistant can actually save the client money and prevent physical and emotional distress. Because the personal assistant is often in close daily contact with the client, he or she is best able to observe food and fluid intake and watch for changes in mood, behavior, and physical and intellectual skills. Simply by being on the scene the personal assistant can often get help for small problems before they become large problems.

Finding a Personal Assistant

Older Women Fit the Role

Finding the right person for senior care is crucial. Catalina has found that women in their 50s make the best personal assistants, for a number of reasons:

• Many are prepared to stay with one client longer than a young, more mobile worker might.
• Many clients are more comfortable having an older person in their home.
• Schedules and assignments can be tailored to meet not only the senior's needs but the caregiver’s as well. Family needs, other obligations, and financial considerations (such as the need to limit outside income to avoid stiff taxes on Social Security benefits) can be accommodated.

Perhaps the best explanation for Catalina’s success in using older women as personal assistants is that the job offers these women a chance to use skills honed over years of homemaking and family management. For many mid-life women, trying to join the workforce for the first time—or trying to rejoin it at working at home for a number of years—becomes a brutal exercise in rejection.

This is not so when they apply for a position as a personal assistant. This is one job that welcomes older women and actively seeks out what they have to offer. It validates their life experiences; most repay this validation with loyalty, enthusiasm, and energy.

The Role of the Adult Care Agency

Impressive as the numbers are, the growth in job opportunities for home care aides tells only half the story. The other half is how difficult it is to locate and keep qualified employees. There are just not enough trained, qualified home care aides to go around. Turnover rates are extremely high, too—as high as 50% annually in some parts of the country (Wall Street Journal 1994).

Here is where home care agencies come into the picture. Hiring a home care aide through an agency relieves the client of most of the frustration, anxiety, and paperwork associated with being an employer. Every adult care agency offers its own complement of senior services.

Catalina does the following:

• Performs an initial evaluation to determine what level of care the senior needs
• Recruits and screens prospective caregivers and checks their references
• Makes sure caregivers are trained and qualified
• Checks the caregiver’s driving record, driver’s license, and auto insurance
• Tests the caregiver for tuberculosis
• Provides employee benefits and liability insurance
• Takes care of Social Security and income tax withholdings and files all required documents
• Shows the senior ways to work with the personal assistant to build a mutually satisfactory relationship
• Provides regular supervisory visits in the home by a registered nurse

And if the chemistry is not right between the caregiver and client, Catalina finds another personal assistant. The agency knows how important it is to trust and be comfortable with someone who is working in the home.

Growing the Business: In-house Training

To ensure the availability of a reliable pool of qualified home care aides, Catalina created is own training program. A $24,000 grant from an Arizona state program to help small businesses provided 75% of the funding; Catalina provided the rest. The training was offered at no charge to the 60 students who went through the program.

Forty of the students were homemaker-companions and personal assistants who were upgrading their skills to become certified nurse’s aides (CNAs). For these assistants Catalina developed a 150-hour course, approved by the Arizona State Board of Nursing, which doubled the federal minimum training time for CNAs.

The other 20 students were trained as personal as-sistants. Their 60-hour curriculum provided both clini-cal and classroom training, including direct experience working with the residents of a local Veterans Administration facility.
Adult home care professionals are undoubtedly aware of the problems involved in locating and keeping qualified workers. Careful recruiting and encouragement of staff professionalism can help build a skilled, stable team of home care aides. Many of Catalina’s personal assistants have been with the agency—and often with the same client—for years.

By drawing whenever possible on the skills and experiences of mid-life homemakers, other agencies may discover that their personnel office do not really need a revolving door.

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