Home Aides Play Crucial Role in Caring for Elderly

Winifred Wernig never went to medical school. She did not even complete her nursing degree. But in helping fragile elderly patients survive in their own homes, she plays as crucial a role as the most distinguished physician.

The London-born Wernig, who came to the United States 40 years ago at 23, is a home health aide with the nonprofit Visiting Nurse Assn. of Los Angeles. For those barely able to help themselves make it through another difficult day, she helps with the basic tasks of life--getting out of bed, bathing, dressing, cutting their nails and brushing their teeth.

“Some people are able to walk into the shower and you just assist them,” said Wernig, 63, who hits the road at 8 each morning in her white Chevette to begin a full day of visits. “We have a lot of patients who are confined to bed. For them you do everything.”

Agencies Report High Turnover

Consigned to the bottom of the health-care ladder in pay and prestige, health aides earn as little as $4 an hour, although some agencies pay their most valued workers nearly $9. Because of the low wages and the sometimes unpleasant nature of the work, turnover at some agencies is as high as 60% a year, according to Sharon Hamilton, a vice president of Partners in Care, a profit-making subsidiary of the Visiting Nurse Service of New York.

For all their responsibility, home health aides often lack formal education and are subject to little or no government regulation. In California, the Health Services Department requires that aides who work for agencies must have 120 hours of training, but those who work independently, sometimes known as “companions,” do not have to meet even this requirement.

The elderly who turn to agencies for help are at their mercy to provide desirable aides. Sometimes the agencies do a less than thorough job of screening.

Stella Weintraub, a New York City resident who hired an aide through an agency for a bedridden 86-year-old relative, said the aide had a habit of leaving crusts of bread and crumbs scattered about the kitchen. The result: a veritable plague of cockroaches. “After I talked to her, she stopped that and the house is clean now,” Weintraub said.

Aides Are Versatile

A good aide is part personal helper, part psychologist, part substitute relative, although not every patient needs the full range of services.

Ethel Powell, 53, an aide for the Visiting Nurse Assn. of Los Angeles, said that some patients want little more than a friendly soul to chat with. “Sometimes the patient says, ‘Honey, I’ve had my bath. I just want to visit with you.’ ”

But sometimes the aides become a crucial link in the health-care chain. Henrietta Guerra, an aide with National In-Home Health Services in Van Nuys, once suspected that an elderly pneumonia patient was being deprived of food by her brother. Guerra complained, her agency began an investigation and ultimately the family’s minister intervened--and everyone agreed the woman would be safer in a nursing home.