8. How Patients See Home Health Aides – The Aide as Persecutor 1

For some chronically-ill patients, the presence of and need for an aide is so humiliating and enraging, that the aide, regardless of their personal or professional qualities, takes on the persona of persecutor. They come to embody or symbolize the illness or disability to the patient.  While the perception of the aide as persecutor may come largely or even entirely from the patient there are times when the aide is indeed a serious problem.

In this, and in the next few blogs, we shall look at “The aide as persecutor” in a number of iterations. In each case we will look at the aide’s effect upon the patient and what might be done about it.

• The Aide as Idiot

In my many years as therapist to chronically ill and disabled patients, I have heard and heard reported a number of supremely idiotic remarks made by aides with little imagination and no impulse control. Some examples:

Said to a nearly paralyzed patient: “You are so lucky.  You get to spend all day in bed!”

Said to a Jewish patient: “you know, you Jews…….”

Said to a nursing home patient: “In our culture, we NEVER put our relatives in a nursing home. The family always takes care of their own.”

What do you do with someone capable of uttering these inanities? That depends on a number of factors.  If the aide is technically skilled, gentle, efficient, honest and in other ways satisfactory, it might be worth it to try and gently explain that these are offensive remarks.  If necessary, a relative or friend might do so.  Also, how often does the aide make such remarks?  Daily?  Weekly?  Once?  If most of the aide’s other qualities are good or acceptable, it may be worth it to tolerate an occasional stupid remark. If it happens too frequently, then, of course, the aide has to go.

There are some aides who make inappropriate remarks related to religion, diet, or another type of lifestyle choice.

• Aide as fanatic

A number of my patients have reported aides asking about religious beliefs.

• Said to a Moslem patient: “Have you found Jesus as your personal savior, yet?”
• Said to a Jewish patient: “I’m going to pray over you for Jesus to heal you.”
• An aide accompanying a patient in the community engages others in religious talk and leaves religious materials at doctor’s offices and other places they go while she is working.
• Said to a woman with multiple sclerosis: “If you give up nightshade vegetables you might be cured.”
• Said to a male patient with a complicated medication regimen: “You take too many pills. All you need is a multi-vitamin.”
• “You’d feel better if you’d just eliminate gluten!”
• “You’d be able to walk if you’d just get up and try.”
• “I know a Chinese herbalist who could cure you in a moment.”

In such cases, the aide must be told, and in no uncertain terms, that these remarks or actions are uncalled for and unwanted and must stop immediately. If they don’t, the aide must be reported and replaced as soon as possible.  Unfortunately, I have found it is very difficult to stop this sort of behavior for long.  A serious consequence is the only solution.

In the next blog we will talk about other ways aides can annoy, disturb or torment their patients.