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Continued: Care aides get little to no training for life-and-death tasks

  • Article by: CHRIS SERRES , Star Tribune
  • Last update: September 2, 2014 - 2:43 PM

Between medical tasks, caregivers are often expected to do laundry, cook meals and perform other household chores for their clients. In Minnesota, attendants providing overnight care describe sleeping on living-room floors with air mattresses because no spare bed is available, and getting phone calls at all hours of the day from clients who need advice or just someone to talk to.

Job takes physical toll

On a hot July afternoon, sweat poured down Debra Howze’s face as the personal care attendant rushed from one errand to the next. Between house visits, Howze picked up prescription drugs for a client at a pharmacy and did two loads of wash at a laundromat, carting a client’s dirty clothing in the back seat of her car. “I could make the same money waitressing and not have to put up with all this,” Howze, of north Minneapolis, said as she stopped at a CVS Pharmacy drive-through window. “Everything is hurry, hurry, hurry.”

The work is also physically demanding, as many caregivers must push, pull and lift disabled patients on a daily basis. In 2012, the average home health aide missed 14 days of work from injuries and illnesses, 55 percent more than all occupations nationally, according to the Bureau of Labor Statistics. Their median wage: $10 an hour.

For some personal care attendants, the strain can be too much.

Mona Ali of Burnsville, a personal care attendant, said she was asked to care for an elderly woman who depended on a ventilator machine and an intravenous feeding tube. Ali said she received no training on the equipment before being sent to the woman’s home. Instead, a nurse with her personal care agency left a handwritten note at the foot of the patient’s bed, instructing Ali to change the IV bag every two hours.

And if the red light on the ventilator stopped blinking? Call 911.

“I kept thinking, ‘What if I end up killing this person?’ ” Ali said. “I could not understand why this woman was not receiving care from a skilled nurse.”

Sernett said she has not seen a licensed supervisor in more than four years working as a personal care attendant for a severely disabled client. Yet Sernett, 50, performs a wide range of complicated medical tasks that, if not done correctly, could prove fatal.

On a recent weekday morning her client, Gary Jarvis, a 67-year-old former truck driver and stroke victim, had just awakened and was gagging on the mucus that had collected in his throat overnight. His face had turned red and the veins on his neck bulged as he gasped for air.

Calmly, Sernett inserted a clear plastic tube into his tracheostomy, a permanent opening in his neck connected to a respirator, and drained the excess phlegm. Moments later, she rolled his 190-pound body over so she could wipe his bottom with sterile gloves and clean a reddened sore on his lower back. Then she injected a syringe full of pink Milk of Magnesia into the feeding tube attached to his intestines.

For these and countless other tasks, Sernett said she received “absolutely no training” from the home care agency that employs her. Sernett said she learned how to suction a tracheostomy and administer a feeding tube from the patient’s wife, Linda Jarvis, 66, who has no formal medical training and learned how to perform the tasks only by watching the hospital nurses who treated her husband after his stroke 14 years ago.

“This ought to be illegal,” Sernett said, as she cleaned the skin around the man’s feeding tube with a cotton swab and a washcloth. “I find it completely outrageous that a man’s life rests in the hands of people who are completely unsupervised and untrained.”

The living room of the couple’s East St. Paul home resembles an emergency room, with piles of sterile bandages and more than $50,000 in medical equipment surrounding a hospital-style bed. There are only a few signs of the comforts of home: a wooden crucifix above his bed, a collection of model trucks, and the faint sound of country music from a nearby stereo.

Six months from now, Sernett will no longer be able to care for Jarvis after five years. She will graduate from nursing school and Medical Assistance will no longer pay for her services. “I really love Gary, so it makes me so sad that I can’t stay with him as a nurse,” said Sernett, her eyes tearing up. “He should be getting skilled nursing care every day because his needs are so technical.”

Empowering consumers

Soon, families across Minnesota who depend on personal care assistance could have more control over their own home care and how state funds are spent. Like other states, Minnesota is shifting to a new, “consumer-directed” model of care that would give patients the authority to hire and fire their own personal care assistants and to pay them directly. Instead of relying on the state to pay caregivers, participants could receive monthly cash grants to spend as they see fit on home care.

Families who highly value a caregiver could encourage the person to stay by paying more than the $9 to $10 an hour now offered by many home health companies. Others could use the cash grants to pay for equipment, such as grab bars in bathrooms, which would enable them to live more comfortably at home.

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  • Teri Sernett, left, a personal care attendant, cared for Gary Jarvis with help from his wife, Linda, at the couple’s home.

  • On her way to a client, PCA Debra Howze picked up some prescriptions at a drug store in Brooklyn Park before being on punched in on the clock. This is one of the tasks that is not in the job description of a PCA. ] Richard Tsong-Taatarii/rtsong-taatarii@startribune.com

  • At the home of Linda Jarvis who living room has been turned into a hospital room for husband Gary Jarvis, who suffered a massive stroke and needs 24-hour care, PCA Teri Sernett , right, worked with Linda to put a clean diaper on Gary before moving to his wheelchair using a lift. ] Richard Tsong-Taatarii/rtsong-taatarii@startribune.com

  • Lisa Lassen who lost her father, Kenneth Ell, a retired railroad worker, who died of organ failure stemming from a foot infection due to poor diabetic care described his harrowing last days during a video interview at the grave site in Aberdeen, South Dakota, on July 27, 2014. "I believe 100 percent that my father would still be alive today had he been treated by licensed and trained professionals." ] Richard Tsong-Taatarii/rtsong-taatarii@startribune.com

  • Home Health by the numbers

    Number of Americans who receive home healthcare services: 11 million

    Number of home health aides, nationwide: 875,100

    Percentage of home health aides who are female: 89 percent

    Median annual pay of home health aides, 2012: $20,820

    Federal poverty level for a family of four: $23,850

    Sources: U.S. Bureau of Labor Statistics, Centers for Medicare and Medicaid Services

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