Priscilla Aguirre knelt down to rouse Isabell Bravaro, 87, who was dozing off in her chair. Pestered, Bravaro turned her face toward Aguirre and darted out her tongue. Aguirre flinched, but continued to coax Bravaro out of bed.
It's all part of being an in-home caregiver.
In-home health care is one of the fastest- growing jobs in the United States. Demand for compassionate caregivers like Aguirre is on the rise, but a capable supply of such workers isn't keeping up.
If working in difficult situations with difficult people doesn't turn off potential workers, the low wages and poor benefits do, in-home care workers' unions and recipients say.
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"It's hard because when you find someone who's really good, they move on to another job," said Katherine Caldwell, 54, of Oakdale.
Finding the right fit can be tough. Judy Melton, 78, of Turlock went through 10 in-home care workers in seven years before finding someone who made her feel comfortable.
"If they weren't crazy, they made me think I was crazy. I don't think it's crazy to want someone to do their job, keep their hands off of my medication and jewelry, and not bring their emotions in here," Melton said.
"I'd heard stories of people ripping off old ladies, so I was ready for that. But I didn't expect the saps," she said. "I don't feel sorry for myself, and I don't want anyone else feeling sorry for me, either."
Corie Moyers, service director at Arcadia Health Care in Modesto, is adept at weeding out in-home care applicants who don't belong in the field, but matching in-home care workers with clients is tough, she said.
"The bottom line is: It's up to the client. I interview people and do all I can to have a successful personality match, but I'm not a mind reader," she said.
Sometimes matches don't work because the in-home care provider simply shouldn't have a job in which he or she is responsible for cooking, cleaning, entertaining and ensuring clients take their medication, said Sharon Simmons, who owns Compassionate Care in Modesto.
"I'm learning to read people to protect our clients and protect ourselves, too. You have to be witty. There are some really smart ones that get through, but in time they show their true selves," said Simmons of the search for top-quality in-home caregivers.
"In this business, you have to be compassionate," she said. "You can train a person to do a job, but you can't train people to have compassion. If I don't see that in them, they're out."
Caldwell has been bedridden for six years with health issues that stem from injuries suffered when she fell off of her horse during an endurance ride in a remote mountainous area on the California-Oregon border.
"Since then, I've had the most bizarre assortment of people come through my home: drug addicts, thieves, women with dangerous boyfriends," she said.
Fed up with the situation, Caldwell's daughter, Amy Lowe, finally quit her trucking job, which paid about $1,000 a week, to be her mother's full-time caregiver. Lowe, 24, now makes $358 a week, which is paid through In-Home Support Services.
Few options for low-income recipients
Most families have two options when it comes to in-home care. Low-income recipients can find in-home care workers through the county. Higher-income recipients, who pay out of pocket or with health insurance, generally go to private agencies.
Now that her daughter cares for her, Caldwell understands the irony of a situation in which someone provides constant care, makes about a dollar an hour above minimum wage and doesn't receive health benefits.
As tough as it is to find good help, it can be tougher being the in-home caregiver, Lowe said.
"Don't get me wrong. It's great. The hours are flexible. I can go pick my kids up from school. But you have to do things that aren't so great, like cook and clean. And it doesn't pay enough or provide insurance for me or my kids," she said.
As the population ages and seniors increasingly opt to stay home rather than move to assisted-care facilities, it's getting tougher to find in-home care workers, according to a Paraprofessional Healthcare Institute report.
In-home care workers are expected to be the second-fastest growing job over the next decade, according to the American Association of Homes and Services for the Aging. Demand for in-home care workers is projected to grow by 50 percent.
Currently, in-home care agencies need little more than a business license to place workers in ailing and vulnerable Californians' homes, said Moyers of Arcadia Health Care.
She thinks home-care workers should be state certified, which would include background checks, fingerprinting, blood tests and physicals.
"We're advocates for setting standards," Moyers said.
Taking steps to protect patients
Many agencies already take those steps. Some counties mandate it. Moyers thinks it should be required statewide.
Lola Young agrees. Young is a member of the Gray Panthers, a seniors' organization that, among other things, advocates for health care reform.
"The problem is, the people we're trying to protect, who need in-home care, don't want it because it would limit their choice. The disabled want to choose for themselves who they let in their homes," she said. "I think we need to make it more of a profession than a job, then you're bound to get quality care."
State-mandated training, higher wages and health benefits would attract better people to the field, Young said.
Aguirre and her sister, Connie Calderon, are going to stay in the profession regardless of how attractive it may seem to others.
They work eight to 12 hours a day, three to four days a week and pick up extra time when other caregivers can't make it to work. But it's not about clocking in and out, and counting the money made by the hour, Calderon said.
"This isn't a normal job. We laugh and cry together. We like this because it's a second family for us. We're always told we're appreciated. It motivates you to keep caring in the best way you can," Calderon said.
Bee staff writer Eve Hightower can be reached at firstname.lastname@example.org or 578-2382.