It was the nightly routine of reflexology foot massages that my mother most relished.
Her tirelessly cheerful home health aide, Mary McLendon, would serve her delicious home-cooked dinners before easing my mother into her reclining chair to tenderly knead her arches and soles. The two of them would then talk as confidantes about their lives, hopes and fears while watching Wheel of Fortune.
During a difficult year in which my mother, Jeanette Gilbert, had multiple hospitalizations for falls that would eventually force her to move from her apartment to a nursing home, Mary’s care and their conversations were a salve to soothe the growing despair.
It wasn’t just my mother who was so touched by their relationship. Two years after saying goodbye to us — and seven months after my mother died — Mary called me out of the blue to share her thoughts about my mother. “She was my best friend,” Mary said.
As my mother’s former primary caregiver, I am extremely grateful that Mary came into our lives. We tried out other home health aides who would arrive late and then spend hours playing on their phones rather than attending to my mother’s needs. Their listlessness and distraction made me anxious about relying on them.
But with Mary, I quickly developed complete trust. She arrived on time, smiling, and with a game plan for keeping my mother entertained. She became an indispensable adviser to me, too, writing her insights each day about my mother’s sleep, appetite and state of mind in a lined notebook she left on the dining room table.
According to the U.S. Bureau of Labor Statistics, in 2020 (the most recent data available) there were nearly 3.5 million home health and personal care aides tending to older Americans and those with disabilities. For their hard work, they made a modest $13.02 an hour on average, or a little more than $27,000 a year if doing the job full time.
The good they can do, though, is priceless. A loving, capable aide is often the difference between a successful and failing caregiving plan.
Not everyone is fortunate enough to have a Mary or the kind of friendship that she and my mother formed. But there are ways that family caregivers can find the right aides for their loved ones and foster the most supportive relationships. Here are some ideas.
Insist on consistency
Some home health care agencies make a point of sending one aide on a regular basis to work with a care recipient. Others send different aides for different shifts, based on their staffing needs but not necessarily on the best interests of caregiving families.
A revolving door of new aides means that caregivers have to bring stranger after stranger up to speed. Tell the agency that you want only one aide, if possible, to provide care. The two of you are more likely to develop familiarity and mutual appreciation over time.
Be finicky about fit
No matter how experienced she may be at doling medications, cooking meals and keeping company, not every aide will click with every care recipient and caregiver. (And it probably will be she: Eighty-nine percent of U.S. home health aides are women, according to home-care research and advocacy group PHI.)
This relationship is a little like dating: Chemistry matters. Are the aide and your loved one able to communicate well? Have they found a rapport and rhythm? Do they have common interests and like one another? If not, ask the agency to send another aide for a tryout.
Expect the best from all parties
Aides come with training and directions from their agencies but need to take their specific marching orders from you. Express your expectations to the aide at the outset for when he will arrive, what he will do and how he should communicate with you.
Some care recipients resist having aides and will complain about them at every opportunity. Explain to the recipient that you need her cooperation and forbearance because the service of a high-performing aide is one of the best means of making caregiving more manageable for you.
Connect with the person giving personal care
In the course of their normal duties of showering, dressing and sometimes toileting older adults, home health aides gain a physical intimacy with your vulnerable loved ones. To make this more comfortable for all involved, it is vital to get to know the often kind, caring person attached to the strong arms.
Many hired caregivers are immigrants from cultural traditions of deep respect for elders. (One in three aides is Hispanic or Asian American/Pacific Islander, an October 2021 analysis by the nonprofit Center for Economic and Policy Research found.) They often have compelling stories to tell, if you ask them, of their own lives and struggles. Hearing those stories — and sharing your family’s background in turn — is usually the first step toward establishing real closeness.
Editor's note: This article, originally published Jan. 2, 2018, has been updated with more recent information on the demographics and income of home health workers.
Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.