Patricia Henson of Grove City relies on home health aides. They help her with meals, shopping, transportation and cleaning. She likes the aides that she has now, but that was not always the case.
"They were supposed to help clean, and they didn't do that. They took me to the grocery store. They didn't take me to get haircuts. There were times I wanted to get out and couldn't," she said.
Patricia's 9-year-old daughter, Leah Curry-Furbee, worries about another issue. She lives with her grandmother, but helps her mom when she visits. She said that all the aides have been nice to her, but recalls one incident in particular.
"(A home health aide) got her in a car accident and worried me, and I'm like, ‘where is she?’"
Patricia was taken to a hospital, treated, and released.
An accident with a client is a red flag for Pandora Shaw-Dupras, the C.E.O. of Easter Seals Central and Southeast Ohio.
"How many points are on that driver's license if they're going to be transporting someone?" she asked.
Her agency provides home health aides for 80 to 90 disabled clients. She worries about issues many of us don't think about.
"You want to make certain that at a minimum they've had some training in first aid and CPR so they know what to do in an emergency. Do they know how to appropriately feed someone and have them in the appropriate position so they don't aspirate?"
Providers know this is a field with low pay and hard work. They struggle to attract and keep the good aides.
"It's not easy. Retention is always a challenge," said Jon Hersh, owner of Homewatch Caregivers.
Hersh values his good caregivers and offers health benefits and other perks to keep them. He said that some have been with him for seven or eight years.
Agency owners, as well as family members, want to make sure that caregivers are attentive to the patients' needs, and don't neglect them.
"You shouldn't be sitting there watching television or reading a book," Shaw-Dupras said.
And there's the question of qualifications. On that, the state is silent. Hersh requires the aides at his agency learn many skills.
"From first aid, CPR, Red Cross, to orientations, to bloodborne pathogens, to learning how to delegate medication."
But that's just one agency. Others may or may not offer training. Home health aides paid by Medicaid and Medicare need 60 to 80 hours of education.
Those paid with private money may have no training at all. Ohio requires nail technicians to have 200 hours, but does not regulate the 69,000 who work as home health aides in Ohio. That can mean trouble.
"I've had care providers who have taken clients into parties where there's drugs and alcohol," Shaw-Dupras said.
Jim Minwegen spends his days at home in a hospital bed because of multiple sclerosis. He has partial use of one arm. One night a substitute caregiver fell asleep. He yelled, but could not wake her.
"I grabbed an ice cube out of the drink and threw it at her in the chair to try to wake her up," he said.
After dialing first the agency who supplied her, then another aide he trusted, Minwegen called 911.
"They sent first an emergency squad out, and then the emergency squad called the police," he explained.
He suspects that aide was on drugs.
Shaw-Dupras said she would like Ohio to set standards of care, and certify home health aides. That way, families would know if the people who help their loved ones are honest, reliable, and qualified. And, she said, the aides need supervision. She knows first-hand because she hired aides to care for her grandfather.
"Unless I went and physically checked on them, I didn't know what they were doing. And there's no standard for that."
Watch our web extra for the interview with Shaw-Dupras in which she explains what you need to do and the questions you should ask to find a good caregiver.