Disability Studies Quarterly
Fall 2004, Volume 24, No. 4
<www.dsq-sds.org>
Copyright 2004 by the Society
for Disability Studies


Reminding Ourselves of the Often Overlooked --
Education and Training of Home Health Aides

Mary Ann Price
St. Louis Community College-Forest Park
Email: mprice5804@aol.com

St. Louis has had a disabilities studies program based at St. Louis Community College for 13 years. Other colleges and universities nationwide also offer training programs for paraprofessionals (paras). Classes are usually small, and persons are not usually granted release time from their jobs to attend. In addition, they often are not given monetary increases or promotions after completing the courses. Many paras work double shifts because the salaries are low and there are usually no benefits. Most of our students seek and achieve an Associate's degree or a Certificate of Specialization in Disability Studies because they want to, for their own satisfaction. Unlike other programs, which offer non-credit or continuing education courses, our courses are for credit and some students go on to complete a Bachelor's degree. Those who graduate with the agency/organization competencies that are requested usually work in group homes for adults with developmental disabilities; recreation programs for disabled persons; respite care and day care centers, e.g., Head Start; teacher aides in special education classrooms.

Anna Lou Pickett, the "guru" of training for paraprofessionals at the National Resource Center for Paraprofessionals, has developed curricula and coordinated national conferences particularly for Para educators. These are the persons most likely to receive release time and some tuition reimbursement for courses.

The persons most commonly overlooked for training/education in disability issues are those involved in home health – aides for persons with disabilities. Agencies often put new aides in front of TV/VCR screens, show two or three videos and, in effect say, "Now you are trained and ready to work."

National Independent Living Centers (ILC) and disability rights groups advocate for "consumer directed or self-directed" aide services. Aides and ILCs contend that paraprofessionals should be hired, trained, and fired by the disabled consumer. According an AARP Issue Brief, "A 2002 survey found that more than three-fourths of Americans, aged 50 and older, would prefer to have control over money and management of their workers if they need home care services rather than an agency having control. This certainly would increase the growing need for paras in the area of home health" (2003). As a professional in the field of disabilities and a person experiencing significant multiple physical disabilities, I agree with this philosophy. But there should be more...

Just as Para educators are trained as teacher aides, home health paras need education before entering a person's home. Whether they receive continuing education, or modules that may lead to a credit course, many persons with disabilities agree that training is imperative.

Aides need basic medical training, not just viewing videos with no discussion by an authority on the subject. Aides should know CPR, medicine administration, transfer techniques, information about blood borne pathogens, when not to come to work with something contagious, etc.

As part of a course(s), "common sense" type topics and concepts need to be presented to those health-oriented paras either entering or already in the field. Additionally, the disabled consumer should be encouraged to take advantage of the training. I am also not negating the idea that the consumer should train aides, because each disabled person's needs are very different.

The topics, in no particular order, to be presented may include, but are not limited to:

  • Good Interpersonal Skills – How to increase your "people person" skills.
  • Active Listening Skills – How to really listen and absorb what the persons is actually saying.
  • Observe the Person with the Disability – Are there different behaviors from day to day? An example of this would be the aide not recognizing that the person seems very confused on a certain day. Is it medication, is it depression, etc.? The aide is not to "diagnose" but just report any strange behavior to their affiliated agency or to a family member is in the picture.
  • Take Initiative – If a lot of work needs to be accomplished, the aide shouldn't wait for the disabled consumer to give a "laundry list" of chores. They should not expect to sit on the sofa with a "break" while the person is on the phone.
  • The aide and consumer can mutually decide on a schedule. Example: what day(s) the bed gets changed, the plants watered, etc. However, both parties must keep in mind that schedules can be broken – be flexible.
  • Both parties need patience. The aide should be patient with the way the disabled consumer completes a task. They shouldn't try to "hurry" the person to do things for them "to get it done quickly." The disabled person should always be "calling the shots."
  • There needs to always be a constant communication between aide and consumer. That is the only way tasks will be completed expeditiously and correctly.
  • Prompt the aide to ask questions if they are not sure of how to a task. Asking is parallel to good communication.
  • Make sure that a person speaking a foreign language has good enough English to communicate effectively. Many "mishaps" can take place if this is not the case.
  • The aide needs to understand adaptive equipment. Teaching about motorized wheelchairs, lifts on vans, Hoyer lifts, etc. is crucial.
  • Problem Solving and Decision-Making – Two very important concepts to be learned.
  • Companionship – Some aides think they are hired to keep the disabled person company – to be a friend. They need to understand that they are to work unless asked by the person to sit and chat.

The consumer through everyday interactions could indeed teach these concepts. However, this should not have to be on-the-job training. Many disabled persons do have lives in and outside of the home. They are busy. That is the reason they choose to live independently.

A train-the-trainer model with disabled instructors could be very effective with the newly hired aide. Persons with disabilities know only too well what living with aides can be.

As noted, these concepts are not all-inclusive. They are only suggestions for curriculum development. If we can only have agencies comply to have aides receive some form of instruction, we will make significant progress with the "revolving door syndrome." Aides are here today, gone tomorrow. Baby boomers, many of whom are starting to develop disabilities and are in need of having aides themselves, will not likely tolerate untrained persons.

Judith Heumann, former Assistant Director, Office of Special Education Services, under President Clinton, says it best: "Independent living is not doing things by yourself. It is being in control of how things are done" (2003).

Aides and consumers can be a very effective team!

References:

Heumann, J. (2003, October). Consumer-Director of Personal Care Services for Older People in the U.S. [Revised and Updated by Barbara Coleman]. Washington, DC: AARP Public Policy Institute.