Patrice Charles braced herself at the bedside and slowly, gently, began rolling the paralyzed woman over in bed, carefully tucking a fluffy white bath towel under the woman's hip.
"That's how you prevent dislocation of the hip," said Charles, an occupational therapist, speaking to a group of a dozen women who crowded around a hospital bed yesterday at D.C. General Hospital. Then the women, ranging in age from 16 to 76, took turns trying to move the patient, actually a nonparalyzed volunteer.
Severe injuries--both for the disabled and for their caretakers--often result when untrained attendants try to help the handicapped, according to city officials, who have launched a new program aimed at teaching many of Washington's 700 "personal care aides" how to care properly for more than 1,000 severely disabled and homebound persons.
"The lack of trained care aides is a major reason why people end up in nursing homes," said Adam E. Maier, executive director of Independent Living for the Handicapped Inc. ILH, which is running the $40,000 training program--one of only several like it in the country--is a local organization of severely disabled adults and their families founded in 1974.
"An unskilled person can turn a routine task into a life-threatening situation," Maier said in the application for funding the program.
With a curriculum that ranges from how to move a 250-pound paraplegic from his wheelchair to a discussion about the sex life of the disabled, the 30-hour course is aimed largely at combatting what city officials acknowledge to be a lack of training for personal care aides, who earn $3.50 hourly for feeding, bathing, and otherwise caring for the severely handicapped.
Care by the aides, on which the city spends more than $2 million yearly, is available under the Medicaid program to persons earning less than about $300 monthly.
With low pay and difficult working conditions, the turnover rate among the aides is more than 200 per month, leaving many disabled persons in unskilled hands, according to Department of Human Services officials.
In addition to "hands-on" training, the new program also stresses psychological and emotional aspects of disabilities, such as the need for the handicapped to attempt to do some things for themselves, Maier said.
"If a parent always does things for a child, all the time, that child never learns," Charles told the trainees. "You are trying to help a person take charge of their own environment."
That idea, Maier said, is part of a recent nationwide emphasis among the handicapped to promote "independent living skills."
"It has become a sort of civil rights concern," he said, "realizing the handicapped have a right to learn independence, rather than the right to be cared for."
In addition to 60 personal care aides to be trained initially, some 30 family members and disabled persons themselves are participating.
Dr. Constance Battle, the medical director of the Hospital for Sick Children in Northeast, said she enrolled in the program to learn how to better care for her daughter, Ursula, 14, who suffers from severe cerebral palsy.
Battle, a pediatrician, said she was surprised to learn of new lotions, massages and other methods of combatting bedsores, and also benefited from the discussions. "Some people know almost instinctively how to take care of the disabled, how to help them without demeaning them and making them too dependent," she said. "Someone might need just a little help getting a shirt on, but doesn't want someone to do the whole thing for them."
Battle said she is so impressed with the training that she is considering starting a similar program at her 80-bed hospital.
Personal care aide Edith High, 53, a retired government clerk from Northwest, said she learned new massages and methods to move patients. High said she currently cares for a 63-year-old man who has had both legs amputated. "I'll be more ready to handle him, and I'll be ready for more patients" in the future, she said.
"I've learned a lot here," said Sheila Robinson, 28, a nursing student at the University of the District of Columbia, who cares for an 86-year-old senile woman in Northwest. "People in hospitals know how to work with sick people, but not with the handicapped. I'm learning about handling people, and talking to them. It's something I didn't think about as much."