The number of home health aides is dwindling so quickly that there might not be enough of them to care for aging baby boomers.
Mary Meeks hasn't spoken in years.
After strokes and a heart attack, the fragile 90-year-old woman is confined to a hospital bed and fed through a tube. Some days, she doesn't respond to visitors.
But when her home health aide, Pam Pooley, enters the room, Mrs. Meeks comes alive. She holds out her arms and reaches for Pooley.
"When she does that, it is the highlight of my day," Pooley said. "It's really cool."
Pooley, 41, spends two hours a day, twice a week at Meeks' Clearwater home. She cleans the bathroom, changes Mrs. Meeks' bed, does the laundry and the grocery shopping. She also bathes and dresses Mrs. Meeks, relieving her son, James, who rarely leaves his mother's side.
"I love what I do," Pooley said. "My work is so necessary. And every day is a blast."
Pooley and other home health aides say their jobs offer significant rewards: appreciation from their clients, admiration from clients' families, even the inner satisfaction of knowing that they're making a difference.
But financial gain isn't among those rewards. Low income, long hours and few benefits have driven many from the vocation.
Pooley is about to join those who flee. She wants to train for a better-paying job in the computer industry.
Because of such departures, the pool of home health workers is diminishing. The drop is so rapid that a state panel recently recommended lowering standards for training and testing, in order to attract more employees.
Pooley's situation illuminates the problem.
She wants to begin classes to become a computer programmer. The pay will be better, as much as $60,000 annually compared to the $20,000 or less home health aides make. And she will be qualified to work for a company that offers its employees health insurance and pension plans.
"Now I put in 11 hours and get paid for 8, I have no health insurance and if I'm sick and can't work, I get no pay.
"These are some of the things we deal with," said Pooley, who has three children and a disabled husband.
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Other home health aides agree the job is a tough one for such small paychecks. "We don't make enough for what we do," said Tresa Beach, who would like to get into nursing.
Because of the shortage, agencies vie for good employees. Some offer incentives such as bonuses for signing up. Others give free training. Currently, home health aides must have 45 hours of training.
The required training goes up to 75 hours if aides work with medicare patients. Aides are also required to get 12 hours of in-service training each year they are on the job.
The state is studying the problem. Unless something is done, experts say, there won't be enough home health aides to care for the baby boomers as they age.
Gail Case, a nurse who supervises home health aides for Neighborly Senior Services, said an inadequate number of home health providers will force many senior adults into nursing homes and assisted living facilities before it is necessary.
"The 80-to-85 age group is the fastest growing in this country," Case said. "Almost all of them want to live in their own homes as long as they can."
Case said the best home health aides work because they genuinely care for other people. Some of the tasks are unpleasant, she said. Not everyone can change the diaper of an incontinent client.
"I enjoy my work," said home health aide Lina Gutowski, who helps clients with housekeeping, laundry and other tasks. "It makes me feel good when I can help somebody who is older and helpless."
Tiffany Moore, 23, feels the same about her work. "Every place I go, the clients are so glad to see me," she said. "I know they need me."
"They get upset if you don't show," said Janet Nioso, also a home health aide.
Moore said before she became a home health aide, she worked as a telemarketer for about the same amount of pay. Being a home health aide is better, she said, because she can set her own hours.
"This is a career," she said. "I am a professional. The other was just a job."
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Twice each week, home health aide Anita Miller comes to Mary Brumbelow's apartment in Dunedin to help out. She shops, picks up prescriptions, cleans the house and does the laundry.
"I love it when she comes," Mrs. Brumbelow said. "She washes my hair."
Mrs. Brumbelow is 72 and a victim of phlebitis, cellulitis and a skin disease. She has trouble walking.
Without Miller, "I don't know what I would do," Mrs. Brumbelow said.
Miller, a single parent with two daughters, has been a home health aide for 10 years. She said she wishes the job offered benefits such as health insurance. But overall, she likes her profession. "You have to be dedicated," Miller said. "I think most of us are."
Joan Holstein is dedicated.
She drives three days a week from her home in Crystal River to Dunedin to care for Margaret Douglas, who is 94. Holstein said she gave up her job with Mrs. Douglas when she and her family moved from Pinellas County a couple of years ago. But one day after the move, "I decided _ I can't stand it. I have to go back to Margaret."
On work days, Holstein, employed by Ultimate Home Care Services, gets up at 4 a.m. to be at work by 7. She works a 12-hour shift and then returns to Crystal River. She maintains Mrs. Douglas' house, does the laundry, cooks and entertains her client.
"It's important to get them out," she said, explaining that the two visit Wal-Mart, Publix, the beach, the Dunedin Marina, and Mrs. Douglas's sister on a regular basis. Too cold to venture out last Thursday, Holstein wrapped Mrs. Douglas in an afghan and served her hot chocolate with little marshmallows. "You must take some to your husband," Mrs. Douglas told Holstein.
Holstein assured her she would.
Holstein said she opposes eliminating training for home health aides. "There are so many things you have to know to do this job right," she said. Without the proper training, "you could injure your patient or yourself."
She said she knows a home health aide who was injured trying to lift a client that weighed more than 300 pounds. The client fell on the aide and the aide will never work again, Holstein said.
Despite the liabilities, Holstein said there is no other career she would want to pursue.
"I really love my job," she said. "Or I wouldn't be here."